Authors: Zervou, Sevasti; Khan, Michael

Source: Vascular Disease Prevention, Volume 4, Number 2, May 2007 , pp. 125-139(15)

Publisher: Bentham Science Publishers

Abstract:

The accumulated wisdom of the last decade has fuelled a view of diabetes as an unusually severe form of cardiovascular disease (CVD) with a poor prognosis. Diabetic patients expect an up to 3-fold increase in coronary heart disease (CHD) events, independent of other traditional CVD risk factors, but those with CVD fair worse than their nondiabetic counterparts.

The available therapeutic agents with the strongest current evidential support in prevention of CVD in diabetes are not those which primarily reduce blood glucose levels but rather those which reduce low density lipoprotein cholesterol or blood pressure. Current results from clinical trials are rather disappointing in reducing CVD events. Despite important reductions in relative risk in trials of statins, antihypertensive agents and those targeting the renin-angiotensin system there is a desperate need for new effective agents that can combat atherogenic factors including low high density lipoprotein cholesterol and raised triglyceride-rich particles, hyperinsulinaemia and notably the effects of high glucose on the arterial wall; not only to prevent CVD (macrovascular) but also the microvascular complications that are the cause of so much morbidity.

To achieve this goal we must elucidate the pathophysiological role of glucose in endothelial dysfunction and atherogenesis, and begin to explain how elevated blood glucose itself (independent of other atherogenic features of the metabolic syndrome) might damage the arterial wall. Finally, we need to know to what extent any adverse effects of elevated glucose may be reversed if blood glucose levels are normalised.

Unique model systems will contribute to understanding the direct and isolated effect of hyperglycaemia on the atherogenic process. We hope that this knowledge will help correct the anomalous situation whereby glucose-lowering drugs fail to demonstrate significant benefits in prevention of CVD.

Keywords: Cardiovascular disease; hyperglycaemia; dyslipidaemia; hypertension; diabetes mellitus; atherosclerosis; arterial wall; glucose; cardiovascular risk

Document Type: Research article

DOI: http://dx.doi.org/10.2174/156727007780599449

Affiliations: 1: Biomedical Research Institute,Department of Biological Sciences, University of Warwick, Coventry,CV4 7AL, UK.

Publication date: 2007-05-01

More about this publication?

• Vascular Disease Prevention publishes reviews as well as original papers to update all those concerned with this topic at the clinical or scientific level. In addition to clinically relevant topics, we consider reviews and original papers dealing with the more scientific aspects of vascular disease prevention. This includes the evaluation of emerging vascular risk factors, research dealing with the pathogenesis of atherosclerosis and the investigation of new treatment options both at the clinical and scientific level (e.g. epidemiology, patient-based studies, experimental models, in vitro experiments or molecular research). Therefore, another function of Vascular Disease Prevention is to bridge the gap between clinical practice and ongoing laboratory-based research.
  
  In particular, we welcome critical reviews and comments on recent trials. This is a topic that requires regular updates because of the large number of trials published every year.
  
  Debates are encouraged in the correspondence section of this journal.
  The editorial structure of Vascular Disease Prevention is set up with the aim of dealing with the submitted material as rapidly as possible. Specialist editors will provide a more expert and rapid assessment unlike a more centralized editorial structure.

Related content

• In this: publication
• By this: publisher
• In this Subject: Cardiovascular Medicine
• By this author: Zervou, Sevasti ;  Khan, Michael

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers