The effects of modern antihyperglycemic therapy on the cardiovascular system

Šećerna bolest tipa 2 jest kronična metabolička bolest koju karakteriziraju inzulinska rezistencija i disfunkcija β-stanica. Njezina prevalencija je u stalnom porastu i pretpostavlja se da će do 2030. godine broj oboljelih u svijetu prijeći 578 milijuna. Ona sa sobom nosi brojne komplikacije od kojih se najveća važnost pridaje kardiovaskularnima. Kardiovaskularne bolesti najveći su uzrok morbiditeta i mortaliteta kod oboljelih od šećerne bolesti tipa 2. Njihova je incidencija 2-3 puta veća kod bolesnika sa šećernom bolešću od one u općoj populaciji i smatra se da svako povišenje glukoze u krvi natašte za 1 mmol/L povećava rizik za kardiovaskularni incident ili smrt za 17 %. Dijagnoza postavljena s 45 godina povezuje se sa 6 godina kraćim životnim vijekom, a ako je postavljena u adolescenciji, skraćuje očekivano trajanje života za čak 12 godina. Američka agencija za hranu i lijekove zajedno s ostalim regulatornim agencijama donijela je odluku da svi novi antihiperglikemici moraju pokazati kardiovaskularnu sigurnost. Agonisti GLP-1 receptora i SGLT-2 inhibitori pokazali su se neštetnima, čak i superiornima, u smanjenju rizika za smrtnost od kardiovaskularnih uzroka i razvoja srčanog infarkta, moždanog udara ili srčanog zatajivanja. Provedene su i brojne manje studije koje potvrđuju njihov protektivni učinak na ishod i razvoj kardiovaskularnih bolesti, kao i bolju kontrolu samih rizičnih čimbenika. Uzimajući sve to u obzir, međunarodne i hrvatske smjernice smjestile su ih na vrh algoritma za terapiju šećerne bolesti tipa 2.Type 2 diabetes is a chronic metabolic disease characterized by insulin-resistance and β-cell dysfunction. Its prevalence is constantly increasing and it is estimated that by 2030 the number of patients in the world will exceed 578 million. Type 2 diabetes is associated with numerous complications, of which the greatest importance is given to those cardiovascular. Cardiovascular diseases are the largest cause of morbidity and mortality in patients with type 2 diabetes. Their incidence is 2-3 times higher in patients with diabetes than in the general population and it is believed that any increase in fasting blood glucose by 1 mmol/L increases risk of cardiovascular incident or death by 17 %. The diagnosis made at the age of 45 is associated with a 6-year shorter life expectancy, and if it is diagnosed in adolescence, life expectancy is shortened by as much as 12 years. The U.S. Food and Drug Administration, along with other regulatory agencies, has decided that all new antihyperglycemics must demonstrate cardiovascular safety. GLP-1 agonists and SGLT-2 inhibitors have been shown to be harmless, even superior in reducing the risk of mortality from cardiovascular causes and reduced the risk development of myocardial infarction, stroke, or heart failure. Numerous smaller studies have been conducted confirming their protective effect on the outcome and development of cardiovascular diseases, as well as better control of their risk factors. Taking all this into account, international and Croatian guidelines have placed them at the top of the algorithm for the treatment of type 2 diabetes