Progression Of Macrovascular Complications Research Articles

Prevention of Vascular Complications in Diabetes Mellitus Patients: Focus on the Arterial Wall.

In Diabetes Mellitus (DM), hyperglycaemia and insulin resistance progressively lead to both microvascular and macrovascular complications. Whereas the incidence of microvascular complications is closely related to tight glycaemic control, this does not apply to macrovascular complications. Hyperglycaemia influences many interweaving molecular pathways that initially lead to increased oxidative stress, increased inflammation and endothelial dysfunction. The latter represents the initial in both types of vascular complications; it represents the "obligatory damage" in microvascular complications development and only "introductory damage" in macrovascular complications development. Other risk factors, such as arterial hypertension and dyslipidaemia, also play an important role in the progression of macrovascular complications. All these effects accumulate and lead to functional and structural arterial wall damage. In the end, all factors combined lead to the promotion of atherosclerosis and consequently major adverse cardiovascular events. If we accept the pivotal role of vascular wall impairment in the pathogenesis and progression of microvascular and macrovascular complications, treatment focused directly on the arterial wall should be one of the priorities in prevention of vascular complications in patients with DM. In this review, an innovative approach aimed at improving arterial wall dysfunction is described, which may show efficacy in clinical studies. In addition, the potential protective effects of current treatment approaches targeting the arterial wall are summarised.

CON: Glucose is the most important target for cardiovascular prevention in diabetes

The overall impact of glucose-lowering on vascular complications and major clinical outcomes, including mortality, in type 2 diabetes is still an open issue. While intensive glucose control has undoubted benefit for microvascular endpoints, the relationship between glucose-lowering approaches and reduced incidence and/or progression of macrovascular complications is less clear. This presentation will discuss the effect of glucose-lowering per se as well as the effects of specific glucose-lowering therapies on vascular outcomes in type 2 diabetes. Recent analyses from large cardiovascular outcome studies (ACCORD, ADVANCE, VADT) provide new information on factors that modulate the impact of intensive glucose-lowering on outcomes, helping to identify the specific clinical characteristics of the patients receiving the intervention that would show better response. Several studies on cardiovascular outcomes with diabetes drugs are now available, and they highlight cardiovascular benefits from using specific medications, as for the SGLT-2 blockers and some GLP-1 receptor agonists.

Glucose Control and Vascular Outcomes in Type 2 Diabetes: Is the Picture Clear?

The overall impact of glucose lowering on vascular complications and major clinical outcomes, including mortality, in type 2 diabetes is still an open issue. While intensive glucose control has undoubted benefit for microvascular end points, the relationship between glucose-lowering approaches and reduced incidence and/or progression of macrovascular complications is less clear. This review article will discuss the effect of glucose lowering per se as well as the effects of specific glucose-lowering therapies on vascular outcomes in type 2 diabetes. The role of lifestyle changes on cardiovascular outcomes will be also addressed. Recent analyses from large cardiovascular outcome studies (ACCORD, ADVANCE, and VADT) provide new information on factors that modulate the impact of intensive glucose lowering on outcomes, helping to identify the specific clinical characteristics of the patients receiving the intervention that would show a better response. While several studies on cardiovascular outcomes with diabetes drugs are available, they do not clearly highlight a benefit from using a specific medication or will require additional evidence, as for the sodium-glucose cotransporter 2 blockers.