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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prevalence of the Type 2 diabetes mellitus (DM2) has been rising in the whole word. It is assumed that before DM2 develops, patients undergo a stadium of impaired glucose tolerance (IGT) or they have impaired fasting glycaemia (IFG). The confirmed IFG or IGT represent strong predictors of DM2 manifestation and at the same time they are related with high cardiovascular risk, namely with IGT. Other significant risk factor (RF) of DM2 is the obesity and metabolic syndrome. Recent clinical studies have shown that some metabolic abnormalities, which precede development of DM2 can be positively influenced by the lifestyle changes, including improvement of the diet and increasing the physical activity. Such measures can prevent or at least to delay the development of type 2 diabetes mellitus and thus the development of cardiovascular diseases. Positive effect has also the administration of some drugs, already tested in clinical studies, namely glitasons, metromin, inhibitor of ACE, sartans and other.
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PMID:[Contemporary prospects of prevention of type 2 diabetes mellitus]. 1588 94

Metabolic syndrome represents a common risk factor for premature cardiovascular disease and cancer whose core cluster includes diabetes, hypertension, dyslipidaemia and obesity. The liver is a target organ in metabolic syndrome patients in which it manifests itself with non-alcoholic fatty liver disease spanning steatosis through hepatocellular carcinoma via steatohepatitis and cirrhosis. Given that metabolic syndrome and non-alcoholic fatty liver disease affect the same insulin-resistant patients, not unexpectedly, there are amazing similarities between metabolic syndrome and non-alcoholic fatty liver disease in terms of prevalence, pathogenesis, clinical features and outcome. The available drug weaponry for metabolic syndrome includes aspirin, metformin, peroxisome proliferator-activated receptor agonists, statins, ACE (angiotensin I-converting enzyme) inhibitors and sartans, which are potentially or clinically useful also to the non-alcoholic fatty liver disease patient. Studies are needed to highlight the grey areas in this topic. Issues to be addressed include: diagnostic criteria for metabolic syndrome; nomenclature of non-alcoholic fatty liver disease; enlargement of the clinical spectrum and characterization of the prognosis of insulin resistance-related diseases; evaluation of the most specific clinical predictors of metabolic syndrome/non-alcoholic fatty liver disease and assessment of their variability over the time; characterization of the importance of new risk factors for metabolic syndrome with regard to the development and progression of non-alcoholic fatty liver disease.
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PMID:Review article: the metabolic syndrome and non-alcoholic fatty liver disease. 1622 69

There is a 50 % prevalence of obesity with arterial hypertension. This ratio can increase up to 80 %, depending on body mass index. Important pathogenetic origins are quantity of visceral body fat along with the activation of neuroendocrineum (sympathicus, renin-angiotensin system), an induction of insulin resistance with hyperinsulinemia, and a direct compression of the medulla by fat deposits in the kidneys, which results in hemodynamic changes and an increase in blood pressure. The primary aim is a reduction in weight by means of a balanced diet and life style modification, which can be augmented by weight reducing medication. Orlistat lowers blood pressure and body weight simultaneously, whereas sibutramine accomplishes this only under certain circumstances. Interestingly, blood pressure increases again over the course of 10 years following weight reducing surgical procedures, despite ongoing weight loss. Antihypertensive differential therapy should be focused on pathophysiology and concomitant and target organ disease. Thus ACE inhibitors (alternatively angiotensin receptor blockers), in combination with low dose diuretics, should be preferentially administered, followed by calcium antagonists. Beta blockers should be used if definite cardiac indications are present.
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PMID:[Therapy of obesity-associated hypertension]. 1628 Nov 61

The objectives of this study were to determine post-infarction drug therapy at discharge from hospital and at one year in the Basse Normandie region (France) and the management of risk factors, to compare them with the practice recommended by the French Society of Cardiology and other recent references. Patients whose medical expenses were exonerated by the Social Security for primary myocardial infarction without a history of angioplasty or of coronary bypass grafting between February and September 2002 were reviewed. The data was researched from the hospital, the patient, the attending physician and the data bases of the Social Security. Four hundred and fifteen patients were included. At discharge from hospital the percentages of prescriptions of recommended drugs were as follows: betablockers 85%, antithrombotics 99%, ACE inhibitors 75%, lipid lowering drugs 90%; the four drug families were associated in 63% of cases. There was no significant difference in prescription between hospital discharge and the twelfth months except with regards to ACE inhibitors (68%) and the association of the four drug groups (54%). The prevalence of smoking, hypertension, diabetes, overweight, obesity and dyslipidaemia were respectively 40, 39, 9, 44, 20 and 81% at the time of infarction. At one year, the prevalence of smoking had fallen significantly to 16%; only 10.3% of patients had uncontrolled hypertension and only 29% had not obtained the recommended therapeutic target for LDL-cholesterol. The authors conclude that this analysis shows an adequation of drug prescription to current recommendations and an improvement in risk factor management which should, however, be pursued.
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PMID:[Secondary prevention of myocardial infarction in the Basse-Normandie region]. 1629 40

Although the year 2005 has reinforced the therapeutic advances of 2004, with confirmation of certain concepts, the 'coxib affair' has continued to provoke arguments between pharmaceutical companies, licensing agencies as well as patients, some of whom have amalgamated into consumer groups to reject en masse placing any responsibility on the prescribers in favour of an attack on the drug licensing process itself. Among the cardiovascular drugs that will soon be licensed, only ivabradine in stable angina, and remodulin in primary pulmonary arterial hypertension are new. The therapeutic advances in 2005 regarding platelet aggregation and blood coagulation have been significant, in the human, scientific and commercial context, while hypertension has not been ignored. Another new development is the ever more precise notion of the metabolic syndrome, a target of choice for the pharmaceutical industry. The potential range of applications has been widened to include obesity, hypertension, diabetes, HDL cholesterol... The licensing authorities find themselves facing a hurdle to overcome, with novel combinations of drugs (ACE inhibitors, calcium blockers/statins, statins/aspirin, ARA2/calcium blockers...).
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PMID:[The best of clinical cardiovascular pharmacology in 2005]. 1647 71

While diabetes mellitus is most often associated with hypertension, dyslipidemia, and obesity, these factors do not fully account for the increased burden of cardiovascular disease in patients with the disease. This strengthens the need for comprehensive studies investigating the underlying mechanisms mediating diabetic cardiovascular disease and, more specifically, diabetes-associated atherosclerosis. In addition to the recognized metabolic abnormalities associated with diabetes mellitus, upregulation of putative pathological pathways such as advanced glycation end products, the renin-angiotensin system, oxidative stress, and increased expression of growth factors and cytokines have been shown to play a causal role in atherosclerotic plaque formation and may explain the increased risk of macrovascular complications. This review discusses the methods used to assess the development of atherosclerosis in the clinic as well as addressing novel biomarkers of atherosclerosis, such as low-density lipoprotein receptor-1. Experimental models of diabetes-associated atherosclerosis are discussed, such as the streptozocin-induced diabetic apolipoprotein E knockout mouse. Results of major clinical trials with inhibitors of putative atherosclerotic pathways are presented. Other topics covered include the role of HMG-CoA reductase inhibitors and fibric acid derivatives with respect to their lipid-altering ability, as well as their emerging pleiotropic anti-atherogenic actions; the effect of inhibiting the renin-angiotensin system by either ACE inhibition or angiotensin II receptor antagonism; the effect of glycemic control and, in particular, the promising role of thiazolidinediones with respect to their direct anti-atherogenic actions; and newly emerging mediators of diabetes-associated atherosclerosis, such as advanced glycation end products, vascular endothelial growth factor and platelet-derived growth factor. Overall, this review aims to highlight the observation that various pathways, both independently and in concert, appear to contribute toward the pathology of diabetes-associated atherosclerosis. Furthermore, it reflects the need for combination therapy to combat this disease.
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PMID:Diabetes mellitus-associated atherosclerosis: mechanisms involved and potential for pharmacological invention. 1648 46

Patients with type 2 diabetes often also exhibit additional features of the metabolic syndrome. These include specifically central obesity triggering development and maintenance of diabetes together with arterial hypertension, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol. Chronic therapy of the metabolic syndrome in diabetics after coronary bypass surgery focuses on changes in lifestyle, i.e., cessation of smoking, changes in nutrition and increase in physical activity. Nutrition aims at fat reduction and modification to reduce saturated fatty acids, to allow mono- and polyunsaturated fatty acids instead, and moderate alcohol consumption. High fiber and complex carbohydrate diet complete the recommendations. Nutrition therapy connected to increases in physical activity are aimed at reducing weight in overweight and obese subjects, which should reduce their body weight by 5 to 10% within about 6 months. Normal weight subjects benefit from increases in physical activity by lipid and glucose regulation as well as by reduction in mortality.Diabetes-specific therapy aims at normoglycemia including postprandial blood glucose levels, reduces blood pressure supported by ACE inhibitors and aims at weight reduction. Reduction of LDL-cholesterol is the first line therapy, also diminishing small-dense LDL particles. Decreasing triglycerides and increasing HDL-cholesterol are further lipid-regulating aims. Specifically diabetics after coronary bypass surgery need LDL-cholesterol levels below 70 mg/d (1.8 mmol/L) and triglycerides below 150 mg/dL (1.7 mmol/L). In addition, in males HDL-cholesterol should be at least above 40 mg/dl (1 mmol/L), in females above 50 mg/dL (1.3 mmol/L).
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PMID:[Long-standing therapy of the metabolic syndrome in diabetics after coronary artery bypass surgery]. 1659 37

Since the 1950s the definition of the aggregate of metabolic disorders possibly presenting with adult obesity has evolved without reaching a unifying agreement on what metabolic syndrome is. After years of consensus on and research into identifying the extent to which certain criteria of metabolic syndrome may be predisposing factors for cardiovascular events, a reverse shift can be noticed in recent studies raising numerous points of contention about various elements that may be diagnostic for the syndrome. Of these, one of the most tenuous is probably arterial hypertension. Uncertainties have emerged regarding the arbitrariness of cut-off values, which differ according to the classification system the study applied, the methods of measurement, and the dilemma of hyperinsulinemia/insulin resistance which is present in only 50-60% of individuals with hypertension. Currently available data fail to solve these conundrums; however, some studies have correlated hypertension and dislipidemia with an increased risk of cardiovascular events. International epidemiologic data indicate that the prevalence of the syndrome varies between populations and between the sexes within the same populations, suggesting that diagnostic criteria need to take better account of ethnic group origin. Prevention of metabolic syndrome is still based on lifestyle changes; the huge risk of an imminent pandemic has called the attention of the American Heart Association to the importance of prevention and early treatment of the pediatric population--a new segment at risk of early cardiovascular events. Pharmacological therapy is directed at controlling various risk factors, particularly hypertension and metabolic disturbances. ACE inhibitors, sartans and statins are currently the drugs of first choice in treating metabolic syndrome.
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PMID:[Metabolic syndrome and hypertension: prevention and treatment]. 1676 Aug 51

Type 2 diabetes and atherosclerotic vascular disease develop in parallel. Prospective epidemiologic studies have shown a striking communality of major risk factors for both diseases. This raises the question of a "common soil". The traits of the metabolic syndrome including dyslipidemia, visceral obesity and hypertension are predictors of type 2 diabetes as well as coronary heart disease. The same applies to the environmental factors: overnutrition, physical inertia and smoking. Visceral obesity, insulin resistance and low-grade inflammation are known as major components of the common soil for metabolic syndrome and coronary heart disease. Depending on the quality of metabolic control diabetes will accelerate the progression of atherosclerosis via unstable plaque formation. The "common soil" concept provides a paradigm for an integrated therapeutic approach. This applies to a lifestyle intervention as well as a rational use of drugs in diseases of the metabolic syndrome. The medication should consider coexisting disorders of the metabolic syndrome to use pleiotropic effects. On the other hand, side effect such as the worsening of blood glucose levels caused by beta-blockers and diuretics should be avoided. The following medication should be preferred in context of the metabolic syndrome: oral antidiabetics such as acarbose, metformin and thiazolidinediones, antihypertensives such as ACE inhibitors and ARBs (angiotensin receptor blockers) and lipid-lowering drugs such as atorvastatin, rosuvastatin, and the modern nicotinic acid derivative Niaspan, respectively. The strategy using synergies in drug treatment can reduce polypharmacy and costs and improve the patients' compliance.
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PMID:[Metabolic syndrome: "common soil" for diabetes and atherosclerosis. Novel approaches to an integrated therapy]. 1677 May 62

The prevalence of type 2 diabetes mellitus continues to rise. Given the associated co-morbidities of obesity, hypertension and cardiovascular disease, the rising incidence of diabetes has important health consequences and efforts to reduce this incidence are critical. Although lifestyle modifications, including weight loss and exercise, are instrumental in the prevention of diabetes, pharmacological therapies that reduce the incidence of diabetes have the significant potential to lower risk. The results of several large clinical trials have demonstrated that treatment with ACE inhibitors and angiotensin receptor antagonists (angiotensin receptor blockers; ARBs) may prevent or delay the onset of diabetes. These trials have demonstrated an approximately 15-30% reduction in the new onset of diabetes in those receiving ACE inhibitors and ARBs when compared with placebo or other active therapy. Although the exact mechanism underlying the effects are not entirely clear, multiple animal and human studies have demonstrated that the renin-angiotensin system plays an important role in glucose homeostasis. Although future prospective studies to clarify the role of ACE inhibitors and ARBs in preventing diabetes are ongoing, there is substantial existing evidence from completed trials that these agents may prevent the onset of diabetes.
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PMID:ACE inhibitors and angiotensin receptor antagonists and the incidence of new-onset diabetes mellitus: an emerging theme. 1682 95


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