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Università Magna Græcia di Catanzaro Dipartimento di Scienze Mediche e Chirurgiche Cattedra e Scuola di Specializzazione in Medicina Interna
Prof. Francesco Perticone
Problematiche CV nel paziente anziano diabetico La gestione della terapia, qual’è il ruolo degli equivalenti
Iperglicemia: cascata di meccanismi fisiopatologici
che portano a morte cardiovascolare
Myocardial
infarction
Neurohormonal
activation
Arrhythmia and loss of
muscle
Remodeling
Ventricular dilatation
Heart
failure
Death
Coronary
thrombosis
Myocardial
ischemia
CAD
Atherosclerosis LVH
Risk factors
Hyperglycemia
Sudden
death
Adapted from Dzau V, et al., E. Am Heart J. 1991;121:1244-1263.
R. Scognamiglio, Circulation 2005
Takimoto E , Kass DA, Hypertension 2007
Molecular signaling pathways linking ROS to cardiac hypertrophy and remodeling
Perticone F et al, J Am Coll Cardiol 1997;29:365-9
Deletion Polymorphism of ACE-Gene and Left Ventricular Hypertrophy
Vasoconstriction Vascular hypertrophy Endothelial dysfunction Atherosclerosis
Target-organ damage precedes clinical events
Decreased GFR
Proteinuria/albuminuria
Glomerulosclerosis
Apoptosis
LVH
Fibrosis
Vascular disease
Pro-thrombotic state
Perticone F et al, J Am Coll Cardiol, 2003
Fasting Insulin and Left Ventricular Mass
G Sesti, F Perticone et al, J Hypertens 2007
LV
MI,
g/m
2
70
120
170
220
0 10 20 30
Insulin, mU/mL
r = 0.636 p< 0.0001
F Perticone et al, J Clin Endocrinol Metab 2001
MVS in pazienti HCV+
Perticone M et al. J Hepatol, 2014
Schillaci G et al., Arch Int Med 2001; 161:886-91
76
78
80
82
84
86
Maximal vasodilatory response to ACh
Esti
ma
ted
GF
R
(mL
/m
in/1
.73
m2)
± 23.2
± 21.6
± 20.1
P < .001 88
90
1st tertile 2nd tertile 3th tertile
Perticone F et al. Circulation 2004
>90 < 60
GFR ml/min
Rischio morte CV
1.90
1.60
1.30
1.00
Perticone F et al. J Hypertens 2009
NO Synthesis
Vasoconstriction
Thrombosis
Superoxide
COX Activity
Thromboxane A2
Prostaglandin H2
Prostacyclin
Inflammation
Leukocyte Adhesion
Endothelial Permeability Foam Cell Formation T-cell Activation
Endothelin
Vasoconstriction
Calcium Mobilization
Endothelial Dysfunction
Hypertension Diabetes
Integrated Cellular Mechanisms of CV Disease
Changes in the 1h-plasma insulin (A) and 1h-plasma
glucose (B) values after six months of antihypertensive
therapy with Olmesartan, compared to baseline *P<0.05
Perticone M et al. submitted
JUPITER study and incident diabetes
Intensive-dose vs Moderate-dose Statin on
Incident Diabetes
Possible mechanisms of statin induced diabetes
0,0
5,0
10,0
15,0
20,0
25,0
30,0
Neoplasia
Vasculopatia
Diabete Mellito tipo 2
BPCO
Cardiopatia Ischemica
Scompenso Cardiaco
Insuff. Renale Cronica
Fibrillazione Atriale
BPCO riacutizzata
Gastrite
Cardiopatia Ipertensiva Artrosi
Ipertrofia Prostatica
Depressione
Anemia
Diverticolosi
Ipercolesterolemia
Valvulopatia
Demenza
Colelitiasi
Polmonite
Ipertensione arteriosa essenziale 78,7%
Donne 50,5% - Uomini 49,5%
