Title Kardiovaskularna sigurnost antidijabetika Author Matej Herceg Mentor Srećko Marušić (mentor)Committee member Vesna Bačić Vrca (član povjerenstva)Committee member Lidija Bach-Rojecky (član povjerenstva)Committee member Srećko Marušić (predsjednik povjerenstva)Granter University of Zagreb Defense date and country 2016, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Cilj istraživanja: Cilj ovog rada bio je prikazati sva trenutno dostupna saznanja o kardiovaskularnoj sigurnosti
neinzulinskih antidijabetika. U posljednjih nekoliko godina pokrenute su velike kliničke studije svih novih antidijabetika zbog novih smjernica FDA o nužnosti provjere kardiovaskularnog profila novoodobrenih lijekova koji se koriste u terapiji šećerne bolesti tipa 2. Kardiovaskularni rizik je u dijabetičara povećan nekoliko puta u odnosu na ostatak populacije te je važno računati na takav rasplet pri odabiru antidijabetičke terapije. Kronične komplikacije šećerne bolesti tipa 2 predstavljaju veliki problem u -liječenju, glavni su uzrok pobola i smrtnosti te utječu na kvalitetu života i na cijenu cjelokupnog liječenja. Najvažnije
makrovaskularne komplikacije šećerne bolesti tipa 2 su koronarna bolest srca, cerebrovaskularna bolest i periferna vaskularna bolest, a upravo su infarkt miokarda i moždani udar vodeći uzroci smrtnosti u šećernoj bolesti tipa 1 i 2.
Materijali i metode: Rad donosi pregled literature o navedenoj temi i navodi trenutna saznanja i procjene o utjecaju antidijabetičkih lijekova na kardiovaskularni sustav, s posebnim naglaskom na makrovaskularne komplikacije šećerne bolesti i dugoročnom praćenju incidencije velikih kardiovaskularnih događaja tijekom primjene ovih lijekova. Kao materijal za izradu ovog rada poslužiti će članci iz relevantnih znanstvenih časopisa, razna kongresna izvješća, poglavlja udžbenika na temu endokrinoloških bolesti te važeće smjernice hrvatskih, europskih i svjetskih udruženja za liječenje šećerne bolesti tipa 2.
Rezultati: U radu su prikazani dostupni podaci o rezultatima završenih velikih kliničkih studija kardiovaskularnih ishoda antidijabetika koji se primjenjuju peroralno i supkutano te dostupni podaci o kliničkim studijama koje su trenutno u tijeku. U raspravi nakon svake studije navedene su kliničke implikacije tih rezultata i mogući utjecaj na važeće smjernice za izbor
antidijabetičke terapije u bolesnika sa šećernom bolesti tipa 2 uz postojeću kardiovaskularnu bolest ili uz visoki kardiovaskularni rizik. Opisane su sve važnije skupine antidijabetika i njihov utjecaj na kardiovaskularni sustav (metformin, sulfonilureje, glinidi, tiazolidindioni, DPP-4 inhibitori, GLP-1 agonisti, inhibitori a-glukozidaze, SGLT2 inhibitori i dr.) te procjena
kardiovaskularne sigurnosti tijekom njihove dugoročne primjene.
Zaključak: Na temelju proučenih rezultata kliničkih studija kardiovaskularnih ishoda i procjeni kardiovaskularnog rizika zaključeno je da neke skupine antidijabetika imaju povoljan učinak na kardiovaskularni sustav, ali i da neke imaju jasna klinička ograničenja zbog mogućeg povećanog kardiovaskularnog rizika. Također, naglašeni su slučajevi gdje procjena kardiovaskularnog rizika još uvijek nije razjašnjena u potpunosti. Pravilno dizajnirane studije prema smjernicama regulatornih agencija dovesti će do novih saznanja i čvršćih dokaza o kardiovaskularnoj sigurnosti novih, ali i postojećih, antidijabetika te dodatno istražiti njihov mogući povoljan učinak na kardiovaskularni sustav u cilju što kvalitetnije terapije šećerne bolesti tipa 2.
Abstract (english) Aim: The aim of this study was to show ali the currently available information about the cardiovascular safety of antidiabetic agents that are administered orally and subcutaneously, with the exception of insulin preparations. Large clinical trials have been launched in the past few years due to new FDA guidelines on the necessity of checking the cardiovascular profile of newly approved drugs used in the treatment of type 2 diabetes. Cardiovascular risk
in diabetic patients increased several times compared to the rest of the population and it is important to take such an outcome into account when choosing antidiabetic therapy. Chronic complications of diabetes type 2 are a major problem in treatment and a major cause of morbidity and mortality. They have an effect on the quality of life and the cost of
the overall treatment. The most important macrovascular complications of type 2 diabetes are coronary heart disease, cerebrovascular disease and peripheral vascular disease. Myocardial infarction and stroke are the leading causes of death in diabetes type 1 and 2.
Materials and methods:
The work reviewed the available literature on the topic and lists current knowledge and assessment of the impact of antidiabetic drugs on the cardiovascular system, with particular emphasis on macrovascular complications of diabetes and long-term monitoring of the incidence of major cardiovascular events during the use of these medications. Articles in
relevant scientific journals, various congress reports, chapters of textbooks on the subject of endocrine diseases and relevant guidelines of the Croatian, European and international associations for the treatment of diabetes type 2 diabetes will serve as material for the preparation of this work.
Results: This paper presents the available data on the results of the completed large clinical cardiovascular outcomes study of antidiabetic agents that are administered orally and subcutaneously, and available data on clinical trials that are currently underway. Clinical implications of these results and the possible impact on the relevant guidelines for the
choice of antidiabetic therapy in patients with type 2 diabetes with existing cardiovascular disease or at high cardiovascular risk are listed in the discussion after each study. Ali the important groups of antidiabetic agents and their effects on the cardiovascular system (metformin, sulfonylurea, glinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, aglucosidase inhibitors, SGLT2 inhibitors, etc.) are described, while assessing cardiovascular safety during their long-term application.
Conclusion: Based on studied clinical results of cardiovascular outcomes and cardiovascular risk assessment it was concluded that some groups of antidiabetic agents have a beneficial effect on the cardiovascular system, but also have some clear clinical limitations due to possible increased cardiovascular risk. Also, cases where the assessment of cardiovascular risk is still not fully understood are highlighted. Properly designed studies according to guidelines of
regulatory agencies will lead to new knowledge and strong evidence for the cardiovascular safety of new and existing antidiabetics and further investigate their possible beneficial effects on the cardiovascular system in order to better treat type 2 diabetes.
Keywords
šećerna bolest tipa 2
glikemija
kardiovaskularni rizik
kardiovaskularna sigurnost
antidijabetici
Keywords (english)
type 2 diabetes
glycemia
cardiovascular risk
cardiovascular safety
antidiabetics
Language croatian URN:NBN urn:nbn:hr:163:766168 Study programme Title: Clinical pharmacy Type of resource Text File origin Born digital Access conditions Access restricted to students and staff of home institution Terms of use Created on 2016-08-29 13:40:26
