Reduction of cardiovascular morbidity and mortality in Type 2 diabetes. A rational approach to hypoglycemic therapy

P. Spallarossa, A. Barsotti, R. Cordera, G. Ghigliotti, D. Maggi, C. Brunelli

Research output: Contribution to journalArticlepeer-review

Abstract

Type 2 diabetes mellitus is the single most important risk factor for the development of coronary artery disease. Unfortunately, the traditional therapeutic strategies for the treatment of hyperglycemia have proven to be ineffective in preventing cardiovascular complications. In recent years the number of available hypoglycemic agents has increased and considerable progress has been made regarding the comprehension of the pathophysiology of diabetes and its vascular complications. In the present article we firstly present benefits and risks of intensive vs standard hypoglycemic intervention, and the pros and cons of therapy targeted to postprandial hyperglycemia. Secondly, we discuss the cardiovascular effects of sulfonylurea agents and insulin, focusing on the role of intensive insulin treatment in the context of acute coronary syndromes. Thirdly, we review the epidemiological, clinical and experimental evidence linking insulin resistance and cardiovascular disease. Finally, we present the rationale and the role of metformin and thiazolidinedione therapy in the prevention of cardiovascular complications. We conclude that the optimal use of the full spectrum of hypoglycemic agents has the potential to play a key role in the prevention of diabetes-related macrovascular complications.

Original languageEnglish
Pages (from-to)485-495
Number of pages11
JournalJournal of Endocrinological Investigation
Volume27
Issue number5
Publication statusPublished - May 2004

Keywords

  • Cardiovascular risk
  • Hyperglycemia
  • Insulin resistance
  • Insulin sensitizing agents
  • Type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology

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