gabriele riccardi chair of endocrinology and metabolic diseases, federico ii university, naples,...

Gabriele RiccardiChair of Endocrinology and Metabolic Diseases,

Federico II University, Naples, Italy

Diabete e danno vascolare: il nesso fisiopatologico comune tra micro e

macroangiopatia

Riccardi G et al, ATVB 1988

Rosenson RS et al, Atherosclerosis 2011

Retinopathy predicts cardiovascular events in type 2 diabetes

P.C.Y. Tong, Diabetic Medicine 2007

Multivariate-adjusted hazard ratio of CV events, renal events, all-cause mortality and composite events in Type 2 Diabetes in

relation to preexisting microangiopathy

Fattori di rischio per lo sviluppo delle complicanze croniche

Fattori genetici

Compenso glicemico insoddisfacente

Durata del diabete

Dislipidemia

Ipertensione arteriosa

Fumo di sigaretta

Sovrappeso

Sedentarietà

Infiammazione subclinica

THE METASCREEN WRITING COMMITTEE* Diabetes Care, 2006

Prognostic value of the Metabolic Syndrome in diabetic patients

UKPDS: Effect of Tight BP vs Tight Glucose Control on CV Events

Tight glucose control (FPG <6 mmol/L)

Tight BP control(BP <150/85 mm Hg)

% R

edu

ctio

n

-50

-40

-30

-20

-10

0

MicrovascularOutcomes Stroke

Any Diabetes End Point Death

UKPDS Group, BMJ 1998

p< 0.05

p< 0.05

p< 0.05

p< 0.05

Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the

Diabetes Atherosclerosis Intervention Study (DIAS).

Ansquer JC et al, Am J Kidney Dis 2005

Life

style

- G

en

eti

cs

Insulin-resistance

Hyperinsulinemia

Platelet

aggregation

NO GlycemiaHDL-Col

Small LDL

Post prandial Triglyceri

de

SNS PAI-1

arterial wall

Muscle cell proliferatio

n

O+

Proposed mechanisms linking insulin-resistance and/or hyperinsulinemia with atherosclerosis

General features of the hyperglycaemia induced tissue damage

WV Brown, Am J Cardiol 2008

AGEs PCK ROS

OssidoNitrico

Adesione LeucocitiCitochine

Chemochine

Proliferazione

Vasodilatazione

Migrazione

ALTERAZIONI DELLA FUNZIONE ENDOTELIALE INDOTTE DALL’IPERGLICEMIA

Incidence of complications in patients with type 2 diabetes by HbA1c- UKPDS

observational study

0

10

20

30

40

50

60

70

<6 6 to 7 7 to 8 8 to 9 9 to 10 >10

Inci

denc

e / 1

000

/ yea

r

MI (fatal + non fatal)

Microvascular disease

HbA1c % BMJ 2000

Adjusted hazard ratios (HR) for all-cause mortality by HbA1c deciles in people given oral hypoglycemic treatment

Currie CJ et al, Lancet 2010

N Engl J Med 2008;358:2545-59

INTENSIVE STANDARD

Achieved median A1C (%)

6.4 7.5

Weight changes

(kg)

+3.5 +0.4

Severe hypos (%) 16.2 5.1

On TZD at study

end (%)

91 58

On insulin at study

end (%)

77 55

THE ACCORD STUDY

an aortic complicated atheromatous lesion with rupture of its fibreous cap

M= media, T= thrombus, LC=lipid core, FC= fibrous cap