Metabolic Insulin Resistance and Cardiovascular System

Kardiovaskularne bolesti (KVB) uzrok su prerane smrti, i u većini razvijenih zemalja, i kod nas. One su velik uzrok onesposobljenosti za rad i u velikoj mjeri povećavaju troškove zdravstvene zaštite. Osnovna patološka promjena u podlozi KVB-a je ateroskleroza, koja se podmuklo razvija godinama. Nagla kardijalna smrt, infarkt miokarda i moždana kap samo su krajnje epizode procesa i obično se javljaju iznenada pa su često mnoge terapijske intervencije samo palijativne. Masovna pojava KVB-a čvrsto je vezana uz način života te fi ziološke čimbenike rizika. Nedvojbeno je dokazano da modifi kacija čimbenika rizika smanjuje morbiditet i mortalitet kod ljudi s prepoznatim ili neprepoznatim KVB-om. Uzrok KVB-a je obično kombinacija nekoliko čimbenika rizika. Prema europskim smjernicama za prevenciju KVB-a u kliničkoj praksi (2003) koje je 2004. godine prihvatilo Hrvatsko kardiološko društvo u suradnji s drugim srodnim društvima, preporučuju se prevencijske smjernice ukupnog KV rizika (sustav SCOR). Neke od kombinacija aterogenih čimbenika rizika od nastanka KVB-a povećavaju ukupni rizik više od drugih ili pojedinačnih. Tako kombinacija hiperglikemije, hipertenzije, hiperlipoproteinemije i centralni tip pretilosti, udruženi s inzulinskom rezistencijom čine metabolički sindrom (sindrom X) koji prema smjernicama ECS-a (Europsko kardiološko društvo) predstavlja osobito visoki kardiovaskularni rizik. Cilj sprečavanja morbiditeta i mortaliteta KVB-a je rana detekcija čimbenika rizika (primarna prevencija) te liječenje pojedinih čimbenika odnosno usporavanje razvoja ateroskleroze (sekundarna prevencija).Cardiovascular diseases (CVD) represent the major cause of premature death in most developed countries and in Croatia as well. They also largely contribute to a diminished work capacity and escalating healthcare costs. The basic pathology is atherosclerosis that develops insidiously over many years. Sudden cardiac death, myocardial infarction and stroke are only the fi nal episodes in this process. As they usually occur abruptly, many therapeutic interventions are only palliative. The mass occurrence of CVD is strongly related to lifestyle and physiological risk factors. It has been unequivocally proven that the risk factor modifi cation reduces morbidity and mortality in people with established and unestablished CVD. CVD is generally caused by a combination of several risk factors. The European Guidelines on CVD Prevention in Clinical Practice (2003), which were accepted by the Croatian Cardiac Society and some other related societies in 2004, recommend a total CV risk estimation as a guide to preventive strategies (the SCORE system). Some combinations of atherogenic risk factors increase the total risk for the development of CVD more than other combinations or single risk factors. The combination of hyperglycaemia, hypertension, hyperlipoproteinaemia and central obesity, associated with insulin resistance, is known as the metabolic syndrome (syndrome X) that, according to the European guidelines, represents a particularly high CVD risk. The aim in the prevention of CVD morbidity and mortality is an early detection of risk factors (primary prevention) and the treatment of single risk factors along with the slowing down of atherosclerosis (secondary prevention)