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      Insuficiencia cardíaca y diabetes: Nuevos tratamientos para la diabetes

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          Abstract

          La diabetes mellitus tipo 2 (DMT2) es una enfermedad cardiometabólica que predispone a complicaciones microvasculares y macrovasculares, incluida la insuficiencia cardíaca (IC). Existen varios mecanismos que pueden explicar el desarrollo de IC en los pacientes con diabetes. A pesar de recibir el tratamiento estándar, los pacientes que padecen DMT2 y enfermedad cardiovascular (CV) establecida, aun permanecen en riesgo, con una expectativa de vida reducida, y por ende, necesitan un tratamiento cardioprotector adicional. Mientras que el control intensivo glucémico ofrece un beneficio sustancial en cuanto a reducción de eventos microvasculares, es insuficiente en cuanto a la reducción de eventos macrovasculares, además el potencial daño que se produce ante la hipoglucemia severa puede contrarrestar el potencial beneficio en el tratamiento intensivo para el descenso de la glucemia. Los tratamientos para el control glucémico que logren mejorar los factores CV y que se extiendan más allá de su efecto glucocéntrico son los que hoy día pueden mejorar la morbi-mortalidad en los pacientes diabéticos. Las nuevas drogas antidiabéticas han tratado de demostrar seguridad CV en especial en el grupo de diabéticos de alto riesgo CV, alguna de ellas ha demostrado reducción en la mortalidad CV y total. El advenimiento de los agonistas de los GLP-1 y de los inhibidores de los SGLT2 ha abierto una nueva era prometedora en el paciente diabético tipo 2.

          Translated abstract

          Insuficiência cardíaca e diabetes Novos tratamentos para diabetes A diabetes mellitus tipo 2 (DMT2) é uma doença cardiometabólica que predispõe a complicações microvasculares e macrovasculares, incluindo insuficiência cardíaca (IC). Existem vários mecanismos que podem explicar o desenvolvimento da IC em pacientes com diabetes. Apesar de receberem o tratamento padrão, os pacientes com DBT II e doença cardiovascular (CV) estabelecida ainda permanecem em risco, com uma expectativa de vida reduzida e, portanto, precisam de um tratamento cardioprotetor adicional. Enquanto o controlo glicémico intensivo proporciona um beneficio substancial na redução de eventos microvasculares, é insuficiente na redução de eventos macrovasculares, e o dano potencial que ocorre antes de hipoglicemia grave pode neutralizar o benefício potencial no tratamento intensivo a diminuição da glicose no sangue. Os tratamentos para o controle glicêmico que melhoram os fatores CV e que se estendem além do seu efeito glicocentrico são aqueles que podem melhorar a morbidade e a mortalidade em pacientes diabéticos atualmente. Os novos antidiabéticos tentaram demonstrar a segurança CV, especialmente no grupo de diabéticos com alto risco CV, alguns deles mostraram uma redução na mortalidade CV e total. O advento dos agonistas do GLP-1 e dos inibidores do SGLT2 abriu uma nova era promissora em pacientes diabéticos tipo 2.

          Translated abstract

          Heart failure and diabetes New treatments for diabetes Type 2 diabetes mellitus (T2DM) is a cardiometabolic disease that predisposes to microvascular and macrovascular complications, including heart failure (HF). There are several mechanisms that can explain the development of HF in patients with diabetes. Despite of receiving the standard treatment for, patients with T2DM and established cardiovascular (CV) disease still remain at risk, with a reduced life expectancy, and therefore, need an additional cardioprotective treatment. While intensive glycemic control offers a substantial benefit in terms of reduction of microvascular events, it is insufficient in terms of reducing macrovascular events, and the potential damage that occurs in the face of severe hypoglycemia can counteract the potential benefit in intensive treatment for the decrease in blood glucose. Treatments for glycemic control that improve CV factors and extend beyond their glucocentric effect are those that can improve morbidity and mortality in diabetic patients today. The new antidiabetic drugs have tried to demonstrate CV safety, especially in the group of diabetics with high CV risk, some of them have shown a reduction in CV and total mortality. The advent of GLP-1 agonists and SGLT2 inhibitors has opened a promising new era in type II diabetic patients.

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          Most cited references 70

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            ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).

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              Impact of diabetes on cardiac structure and function: the strong heart study.

              Whether diabetes mellitus (DM) adversely affects left ventricular (LV) structure and function independently of increases in body mass index (BMI) and blood pressure is controversial. Echocardiography was used in the Strong Heart Study, a study of cardiovascular disease in American Indians, to compare LV measurements between 1810 participants with DM and 944 with normal glucose tolerance. Participants with DM were older (mean age, 60 versus 59 years), had higher BMI (32.4 versus 28.9 kg/m(2)) and systolic blood pressure (133 versus 124 mm Hg), and were more likely to be female, to be on antihypertensive treatment, and to live in Arizona (all P<0.001). In analyses adjusted for covariates, women and men with DM had higher LV mass and wall thicknesses and lower LV fractional shortening, midwall shortening, and stress-corrected midwall shortening (all P<0.002). Pulse pressure/stroke volume, a measure of arterial stiffness, was higher in participants with DM (P<0.001 independent of confounders). Non-insulin-dependent DM has independent adverse cardiac effects, including increased LV mass and wall thicknesses, reduced LV systolic chamber and myocardial function, and increased arterial stiffness. These findings identify adverse cardiovascular effects of DM, independent of associated increases in BMI and arterial pressure, that may contribute to cardiovascular events in diabetic individuals.
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                Author and article information

                Contributors
                Role: ND
                Journal
                ic
                Insuficiencia cardíaca
                Insuf. card.
                Comité Insuficiencia Cardíaca (Ciudad Autónoma de Buenos Aires, , Argentina )
                1852-3862
                September 2018
                : 13
                : 4
                : 155-169
                Affiliations
                Ciudad Autónoma de Buenos Aires. orgnameHipertensión Arterial. orgdiv1Coordinadora Médica de Obesidad y Síndrome Metabólico. orgdiv2Hospital Bernardino Rivadavia. República Argentina.
                orgnameAmerican Heart Association.
                Article
                S1852-38622018000400002

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 105, Pages: 15
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