Lars Rydén

Guías de práctica clínica sobre diabetes, prediabetes y enfermedades cardiovasculares

Preámbulo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Introducción . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Definición, clasificación y cribado de las alteraciones diabéticas y prediabéticas de la glucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Epidemiología de la diabetes, alteraciones en el metabolismo de la homeostasis de la glucosa y riesgo cardiovascular . . . . . . . . . . . . . . . . . . . 8 Identificación de sujetos con alto riesgo de enfermedad cardiovascular o diabetes . . . . 12 Tratamiento para la reducción del riesgo cardiovascular . . . . . . . . . . . . . . . . . . . . . . . . . 15 Tratamiento de la enfermedad cardiovascular . . . 26 Insuficiencia cardiaca y diabetes . . . . . . . . . . . . . 34 Arritmias: fibrilación auricular y muerte súbita . . 36 Enfermedad periférica y cerebrovascular . . . . . . 40 Cuidados intensivos . . . . . . . . . . . . . . . . . . . . . . . 43 Economía sanitaria y diabetes . . . . . . . . . . . . . . . . 45 Bibliografía . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Guías de práctica clínica sobre diabetes, prediabetes y enfermedades cardiovasculares: versión resumida

РЕКОМЕНДАЦИИ ПО ДИАБЕТУ, ПРЕДИАБЕТУ И СЕРДЕЧНО-СОСУДИСТЫМ ЗАБОЛЕВАНИЯМ. EASD/ESC

. Normal 0 false false false RU X-NONE X-NONE MicrosoftInternetExplorer4 ESC GUIDELINES ON DIABETES, PRE-DIABETES, AND CARDIOVASCULAR DISEASES DEVELOPED IN COLLABORATION WITH THE EASD /* Style Definitions */ n table.MsoNormalTable n {mso-style-name:Обычная таблица; n mso-tstyle-rowband-size:0; n mso-tstyle-colband-size:0; n mso-style-noshow:yes; n mso-style-priority:99; n mso-style-qformat:yes; n mso-style-parent:; n mso-padding-alt:0cm 5.4pt 0cm 5.4pt; n mso-para-margin:0cm; n mso-para-margin-bottom:.0001pt; n mso-pagination:widow-orphan; n font-size:12.0pt; n font-family:Gulim,sans-serif;}Authors/Task Force Members: Lars Rydén* (ESC Chairperson) (Sweden), Peter J. Grant* (EASD Chairperson) (UK), Stefan D. Anker (Germany), Christian Berne (Sweden), Francesco Cosentino (Italy), Nicolas Danchin (France), Christi Deaton (UK), Javier Escaned (Spain), Hans-Peter Hammes (Germany), Heikki Huikuri (Finland), Michel Marre (France), Nikolaus Marx (Germany), Linda Mellbin (Sweden), Jan Ostergren (Sweden), Carlo Patrono (Italy), Petar Seferovic (Serbia), Miguel Sousa Uva (Portugal), Marja-Riita Taskinen (Finland), Michal Tendera (Poland), Jaakko Tuomilehto (Finland), Paul Valensi (France), Jose Luis Zamorano (Spain)

The Prognostic Value of Fasting Plasma Glucose, Two-Hour Postload Glucose, and HbA(1c) in Patients With Coronary Artery Disease: A Report From EUROASPIRE IV: A Survey From the European Society of Cardiology

OBJECTIVE Three tests are recommended for identifying dysglycemia: fasting glucose (FPG), 2-h postload glucose (2h-PG) from an oral glucose tolerance test (OGTT), and glycated hemoglobin A1c (HbA1c). This study explored the prognostic value of these screening tests in patients with coronary artery disease (CAD). RESEARCH DESIGN AND METHODS FPG, 2h-PG, and HbA1c were used to screen 4,004 CAD patients without a history of diabetes (age 18–80 years) for dysglycemia. The prognostic value of these tests was studied after 2 years of follow-up. The primary end point included cardiovascular mortality, nonfatal myocardial infarction, stroke, or hospitalization for heart failure and a secondary end point of incident diabetes. RESULTS Complete information including all three glycemic parameters was available in 3,775 patients (94.3%), of whom 246 (6.5%) experienced the primary end point. Neither FPG nor HbA1c predicted the primary outcome, whereas the 2h-PG, dichotomized as <7.8 vs. ≥7.8 mmol/L, was a significant predictor (hazard ratio 1.38, 95% CI 1.07–1.78; P = 0.01). During follow-up, diabetes developed in 78 of the 2,609 patients (3.0%) without diabetes at baseline. An FPG between 6.1 and 6.9 mmol/L did not predict incident diabetes, whereas HbA1c 5.7–6.5% and 2h-PG 7.8–11.0 mmol/L were both significant independent predictors. CONCLUSIONS The 2h-PG, in contrast to FPG and HbA1c, provides significant prognostic information regarding cardiovascular events in patients with CAD. Furthermore, elevated 2h-PG and HbA1c are significant prognostic indicators of an increased risk of incident diabetes.