Diabetes determines an increased risk of micro- and macrovascular complications, and is associated with a growing disability burden. Although the efficacy of intensive glycemic control in reducing the risk of microvascular complications has been firmly established, a lively debate continues on the relationship between intensive glucose control and macrovascular complications. Recently, the conflicting results of randomized controlled trials designed to evaluate the efficacy of intensive glucose control on cardiovascular disease fueled such debate. While the UKPDS post-trial study and the DCCT/EDIC showed an important “legacy effect” with persistent reductions in cardiovascular disease risk, ADVANCE and VADT found no effect of intensive glucose control on major cardiovascular events. The ACCORD study reported an increased risk for cardiovascular and total mortality associated with intensive glucose control. This review explores the value of intensive therapeutic strategies aimed at lowering indices of glycemic control to near-normal levels on the cardiovascular risk of patients with type 1 and 2 diabetes.
Glucose Lowering, Hypoglycemia, and Cardiovascular Disease Risk
REBOLDI, Gianpaolo;
2010
Abstract
Diabetes determines an increased risk of micro- and macrovascular complications, and is associated with a growing disability burden. Although the efficacy of intensive glycemic control in reducing the risk of microvascular complications has been firmly established, a lively debate continues on the relationship between intensive glucose control and macrovascular complications. Recently, the conflicting results of randomized controlled trials designed to evaluate the efficacy of intensive glucose control on cardiovascular disease fueled such debate. While the UKPDS post-trial study and the DCCT/EDIC showed an important “legacy effect” with persistent reductions in cardiovascular disease risk, ADVANCE and VADT found no effect of intensive glucose control on major cardiovascular events. The ACCORD study reported an increased risk for cardiovascular and total mortality associated with intensive glucose control. This review explores the value of intensive therapeutic strategies aimed at lowering indices of glycemic control to near-normal levels on the cardiovascular risk of patients with type 1 and 2 diabetes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.