Specifics in treatment of patients with diabetes type 2 after myocardial infarction

Akutni infarkt miokarda te općenito kardiovaskularne bolesti najčešći su uzrok smrti trenutno u svijetu. Kardiovaskularne komplikacije također su glavni uzrok smrti u pacijenata s dijabetesom tipa 2. Hipertenzija, dislipidemija, abdominalni tip debljine te razina glukoze i HbA1c glikiranog hemoglobina u krvi glavni su čimbenici rizika za nastanak dijabetesa tipa 2 i aterosklerotske kardiovaskularne bolesti. Prva linija liječenja uključuje nefarmakološke mjere, smanjenje tjelesne težine, zdravija prehrana i tjelovježba dovest će do smanjenja prosječne razine glukoze i LDL-kolesterola te triglicerida u krvi i nižeg krvnog tlaka. Zahvaljujući oralnim hipoglikemijskim lijekovima kao što su bigvanidi, derivati sulfonilureje, tiazolidindioni, inkretini, SGLT-2 inhibitori, GLP-1 receptorski agonisti te inzulinskim preparatima, glukoza i dijabetičke komplikacije mogu se dobro prevenirati. Pacijenti koji uz dijabetes tipa 2 boluju i od kardiovaskularne bolesti te su na antihipertenzivnoj i antilipidnoj terapiji moraju biti pod posebnim oprezom od razvoja kardiovaskularnog incidenta. Oni se pokušavaju spriječiti lijekovima za dijabetes koji imaju kardioprotektivno djelovanje i time smanjuju ukupnu smrtnost od infarkta miokarda. GLP-1 agonisti potiču ekskreciju inzulina, sudjeluju u očuvanju funkcionalnosti β stanica gušterače i smanjuju tjelesnu težinu, uz antiaterosklerotski učinak. SGLT-2 inhibitori glikozurijom smanjuju volumen plazme i razinu glukoze, djeluju nefroprotektivno i snižavaju arterijski tlak. U obje skupine lijekova su pojedine supstance smanjile broj neželjeni kardiovaskularnih događaja u randomiziranim studijama. Prva linija terapije, metformin uz hipoglikemijski učinak smanjuje zonu ishemije i vaskularnu upalu te ukupnu smrtnost nakon AIM-a. Sve ove lijekove treba primjenjivati racionalno, u skladu s pacijentovim navikama, razini suradnje sa svojim liječnikom, načinu života te socijalnom i psihofizičkom stanju.Acute myocardial infarction and cardiovascular diseases in general, are currently the most common cause of death in the world. Cardiovascular episodes are also the main cause of death in patients with type 2 diabetes. Hypertension, dyslipidemia, abdominal obesity, and the level of glucose and HbA1c glycated hemoglobin in the blood are the main negative predictive factors for the development of type 2 diabetes and atherosclerotic cardiovascular disease. The first line of treatment includes non-pharmacological interventions like weight reduction, healthier diet and exercise that will lead to reduction in average glucose, LDL-cholesterol and triglyceride levels in the blood as well as lowering of sistolic blood pressure. Thanks to oral hypoglycemic drugs such as biguanides, sulfonylurea derivatives, thiazolidinediones, incretins, SGLT-2 inhibitors, GLP-1 receptor agonists and insulin preparations, blood glucose can be better controled and diabetic complications can be reduced. Patients who, in addition to type 2 diabetes, also suffer from cardiovascular disease and are on antihypertensive and antilipid therapy must be under special percaution due to risks of cardiovascular incidents. These complications are trying to be avoided by diabetes drugs that have a cardioprotective effect and thus reduce the total mortality from myocardial infarction. GLP-1 agonists stimulate insulin secretion, participate in preserving the function of pancreatic β cells and reduce body weight. They have a proven antiatherosclerotic effect. SGLT-2 inhibitors reduce plasma volume and glucose level by excreting glucose through urine, therefore have a nephroprotective effect and lower arterial blood pressure. Substances from both drug classes have been shown to reduce the incidence of major cardiovascular adverse events. The first line drug, metformin with its hypoglycemic effect reduces ischemia zone and vascular inflammation as well as overall mortality after AMI. All these drugs should be used rationally, in accordance with the patient's habits, level of cooperation with his/her doctor, lifestyle and social and psychophysical wellbeing