scholarly journals Reducing cardiovascular risk in diabetes: insights from the ADVANCE study

2013 ◽  
pp. 30-34
Author(s):  
Giuliano Pinna
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Vascular Disease ◽  
Fixed Combination ◽  
Microvascular Complications ◽  
Current Therapy ◽  
Vascular Events ◽  
Advance Study ◽  
Routine Administration

BACKGROUND Blood pressure is an important determinant of the risks of macrovascular and microvascular complications of type 2 diabetes. That’s why guidelines recommend intensive lowering of blood pressure in those patients. The ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation) study has been recently introduced. It assessed the effects of such an approach on vascular disease using a fixed combination of the ACE-inhibitor perindopril, and the diuretic indapamide, in a population of patients with type 2 diabetes and a broad range of blood pressure values. METHODS After a 6-week active run-in period, 11,140 patients with type 2 diabetes were randomised to treatment with a fixed combination of perindopril and indapamide or matching placebo, in addition to current therapy. Primary end-points: major macrovascular and microvascular events, defined as death from cardiovascular disease, non-fatal stroke or non-fatal myocardial infarction, and new or worsening renal or diabetic eye disease. The macrovascular and microvascular composites were analysed jointly and separately. RESULTS To the end of the follow-up a meaningful reduction of the deaths has been obtained, both for cardiovascular causes and for macro and microvascular events, examined in together (in the total) (separately significance has not turned out). The best result has been obtained in the reduction of the renal events. DISCUSSION AND CONCLUSIONS The authors conclude that routine administration of a fixed combination of perindopril and indapamide to patients with type 2 diabetes and with a good controlled blood pressure, was well tolerated and reduced the risks of major vascular events, including death, but it remains the doubt if these results have been obtained because of the better pressure control or are specific of this preconstructed association.

Cardiovascular Risk in Type 2 Diabetes – Reflecting on the ADVANCE Study

2009 ◽  
Vol 05 (0) ◽  
pp. 42
Author(s):  
Sophia Zoungas ◽  
John Chalmers ◽  
Anushka Patel ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Vascular Disease ◽  
Large Scale ◽  
Intensive Glucose Control ◽  
Vascular Events ◽  
Advance Study ◽  
High Blood Glucose

The world is facing an unprecedented increase in type 2 diabetes. Most disability and premature mortality experienced by patients with diabetes is related to vascular disease and, in particular, macrovascular disease (such as coronary heart disease and stroke) and microvascular disease (such as retinopathy, nephropathy and neuropathy). Indeed, around 1.9 million cardiovascular deaths worldwide are attributable to high blood glucose levels and diabetes, as well as to their associated dangerous companions of high blood pressure and abnormal lipid levels. The global economic costs of diabetes, including foregone economic growth and increasing healthcare expenditure, are substantial and are anticipated to grow. Therefore, strategies to reduce disease burden have continued to focus on reducing cardiovascular risk. Recently, a number of large-scale clinical trials have evaluated approaches for managing cardiovascular risk in patients with type 2 diabetes. Among them the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) trial has reported the effects of blood pressure lowering and intensive glucose control on major vascular events in patients with established type 2 diabetes. In this article we summarise the findings of the ADVANCE trial and discuss its relevance to the management of cardiovascular risk in patients with type 2 diabetes worldwide.

Cardiovascular Risk in Type 2 Diabetes – Reflecting on the ADVANCE Study

2009 ◽  
Vol 05 (01) ◽  
pp. 42
Author(s):  
Sophia Zoungas ◽  
John Chalmers ◽  
Anushka Patel ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Vascular Disease ◽  
Large Scale ◽  
Intensive Glucose Control ◽  
Vascular Events ◽  
Advance Study ◽  
High Blood Glucose

The world is facing an unprecedented increase in type 2 diabetes. Most disability and premature mortality experienced by patients with diabetes is related to vascular disease and, in particular, macrovascular disease (such as coronary heart disease and stroke) and microvascular disease (such as retinopathy, nephropathy and neuropathy). Indeed, around 1.9 million cardiovascular deaths worldwide are attributable to high blood glucose levels and diabetes, as well as to their associated dangerous companions of high blood pressure and abnormal lipid levels. The global economic costs of diabetes, including foregone economic growth and increasing healthcare expenditure, are substantial and are anticipated to grow. Therefore, strategies to reduce disease burden have continued to focus on reducing cardiovascular risk. Recently, a number of large-scale clinical trials have evaluated approaches for managing cardiovascular risk in patients with type 2 diabetes. Among them the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) trial has reported the effects of blood pressure lowering and intensive glucose control on major vascular events in patients with established type 2 diabetes. In this article we summarise the findings of the ADVANCE trial and discuss its relevance to the management of cardiovascular risk in patients with type 2 diabetes worldwide.

scholarly journals THE FAMILY DOCTOR’S ROLE IN ACHIEVING TARGET LEVELS OF TREATMENT IN PATIENTS WITH TYPE 2 DIABETES

2020 ◽  
Vol 72 (2) ◽  
pp. 51-58
Author(s):  
О. Korzh ◽  
A. Titkova ◽  
M. Kochuieva ◽  
Yu. Vinnyk ◽  
L. A. Ruban ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Lifestyle Changes ◽  
Treatment Goal ◽  
Treatment Goals ◽  
Factors Associated ◽  
Triple Treatment

The aim of the study was to identify the proportion of patients with type 2 diabetes who were unable toachieve the triple treatment goal for concomitant control of blood glucose level, blood pressure, LDL and modifying factors associated with achieving triple therapy goals. The study included 675 patients with type 2 diabetes,dyslipidemia and hypertension. The analysis was performed using concurrent triple treatment goals with specific levels of HbA1c, LDL and blood pressure as the main result. The questionnaire for patients with dyslipidemiaincluded self-assessment of compliance with prescribed drugs and perceptions related to their understandingand attitude towards lifestyle changes and pharmacological treatment. The results of the analysis of the logistic regression of factors associated with the achievement of triple treatment goals showed that patients whoreceived moderate doses of statins with high intensity were less likely to achieve concurrent treatment of thegoal compared to low intensity. Younger patients were less likely to achieve the triple treatment goal than thoseover 60 years of age. Based on life expectancy, they will be more susceptible to vascular complications due to anearlier onset of the disease and a longer period of time during which these adverse events can develop. Fewerdrugs and a shorter duration of type 2 diabetes were significant factors in the triple control. It was proved thatsimultaneous control of glycemia, hypertension and lipids was achieved in 22.4% of patients, who were affectedby the intensity of statin treatment, the number of diabetic drugs and the presence of concomitant pathology.Thus, the simultaneous achievement of the triple goal is a more comprehensive mitigation measure to reduce therisk of both macro- and microvascular complications

scholarly journals Serum Levels of Progranulin Are Closely Associated with Microvascular Complication in Type 2 Diabetes

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Lin Xu ◽  
Bo Zhou ◽  
Huixia Li ◽  
Jiali Liu ◽  
Junhui Du ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
Linear Regression Analysis ◽  
Serum Levels ◽  
Diabetic Microangiopathy ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Objective. Progranulin (PGRN) was recently introduced as a novel marker of chronic inflammatory response in obesity and type 2 diabetes capable of directly affecting the insulin signaling pathway. This study aimed to investigate the correlation between PGRN and type 2 diabetics with microvascular complications.Methods. PGRN serum levels and glucose metabolism related substance were measured in 84 type 2 diabetic patients with or without microangiopathies and 12 health persons. Further analyses of serum PGRN in different stages of diabetic microangiopathies were conducted.Results. Serum levels of PGRN were markedly higher in type 2 diabetic patients with microangiopathies. PGRN serum levels increased with the progress of diabetic microangiopathies with significantly highest values detectable in clinical diabetic nephropathy (CDN) and proliferative diabetic retinopathy (PDR) groups. Serum PGRN concentrations in all individuals positively and markedly correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), triglyceride (TG), urinary albumin excretion rate (UAER), blood urea nitrogen (BUN), creatinine (CRE), white blood cell (WBC), disease duration, IL-6, and TNF-α, while correlating negatively and significantly with eGFR. Multiple linear regression analysis showed that only UAER and CRE were independently associated with serum PGRN.Conclusion. PGRN might be considered as a marker for diabetic microangiopathy and its severity.

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