1. KARDIOVASKULARNE KOMPLIKACIJE ŠEĆERNE BOLESTI
- Author
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Šimunić, Matea, Klobučar-Majanović, Sanja, Jakljević, Tomislav, Hauser, Goran, and Mrakovčić-Šutić, Ines
- Subjects
SGLT2 inhibitori ,BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Interna medicina ,kronične komplikacije šećerne bolesti ,GLP-1 receptor agonists ,obesity ,kardiovaslularna bolest ,cardiovascular disease ,agonisti GLP-1 receptora ,debljina ,chronic complications of diabetes ,BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Internal Medicine ,SGLT2 inhibitors - Abstract
Šećerna bolest je kronična metabolička bolest praćena čitavim nizom komplikacija čija je pojavnost na globalnoj razini u stalnom porastu posljednjih nekoliko desetljeća. Navedeno zabrinjava ne samo zbog negativnog utjecaja na kvalitetu života i visokih troškova liječenja već i visokog rizika smrtnosti uslijed komplikacija šećerne bolesti. Upravo kardiovaskularne komplikacije (koronarna bolest srca, cerebrovaskularna bolest, periferna vaskularna bolest) predstavljaju vodeći uzrok smrtnosti među oboljelima od šećerne bolesti. Šećerna bolest se smatra stanjem ubrzane ateroskleroze. Inzulinska rezistencija, kronična upala niskog stupnja, endotelna disfunkcija i protrombotičko stanje kao temeljne značajke metaboličkog sindroma osnova su razvoja ne samo šećerne bolesti tipa 2 već i kardiovaskularne bolesti. S obzirom na pritajeni tijek nerijetko su već u trenutku postavljanja dijagnoze šećerne bolesti razvijene makrovaskularne komplikacije. Stoga je od izuzetne važnosti pravodobno dijagnosticirati i od početka ozbiljno shvatiti i liječiti šećernu bolest s ciljem ne samo kontrole glikemije već i svih pridruženih čimbenika KV rizika, uključujući arterijsku hipertenziju i dislipidemiju. Od presudne su važnosti nefarmakološke mjere i promjena stila života s ciljem postizanja i održavanja poželjne tjelesne mase s obzirom da je gotovo 90% osoba sa šećernom bolešću tipa 2 preuhranjeno ili pretilo. Također potrebno je ograničiti unos soli i savjetovati prestanak pušenja. Prilikom odabira medikamentne terapije u svjetlu novih spoznaja o benefitima novijih skupina antihiperglikemika za koje je utvrđeno da povrh regulacije glikemije ostvaruju dodatna djelovanja s povoljnim učinkom na kardiovaskularne ishode izdvajaju se agonisti GLP-1 receptora i SGLT2 inhibitori., Diabetes is a chronic metabolic disease accompanied by a series of complications whose prevalence at the global level is constantly increasing over the last few decades. This is worrying not only because of the negative impact on quality of life and high treatment costs but also the high risk of mortality due to diabetes related complications. Cardiovascular complications (coronary heart disease, cerebrovascular disease, peripheral vascular disease) are the leading cause of death among individuals with diabetes. Diabetes appears to be a condition of accelerated atherosclerosis. Insulin resistance, low-grade chronic inflammation, endothelial dysfunction, and prothrombotic state as the fundamental features of metabolic syndrome are the underlying conditions for the development of both type 2 diabetes and also cardiovascular disease. Given the latent course of the disease, it is not uncommon that diabetic complications are already present at the time of initial diagnosis of type 2 diabetes. Therefore, timely diagnosis and profound understanding and treatment of diabetes are extremely important not only in terms of glycemic control but also of other associated comorbidities, including arterial hypertension and dyslipidemia which contribute substantially to overall CV risk. Non-pharmacological measures and lifestyle changes aiming at achieving and maintaining a healthy body weight are crucial given that almost 90% of people with type 2 diabetes are overweight or obese. Additionally, dietary salt reduction and smoking cessation should be recommended. In the light of new findings on the beneficial effects on cardiovascular outcomes, when choosing between antihyperglycemic agents, GLP-1 receptor agonists and SGLT2 inhibitors stand out for their favourable CV effects in addition to glycemic control.
- Published
- 2020