RESUMEN
Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.
Asunto(s)
Diabetes Mellitus Tipo 2 , Hiperglucemia , Humanos , Hipoglucemiantes/uso terapéutico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Hiperglucemia/tratamiento farmacológico , GlucemiaRESUMEN
Hyper- and dyslipidemia contribute to cardiovascular morbidity and mortality in diabetic patients. Pharmacological therapy to lower LDL cholesterol has convincingly shown to reduce cardiovascular risk in diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the use of lipid-lowering drugs in diabetic patients according to current scientific evidence.
Asunto(s)
Diabetes Mellitus Tipo 2 , Dislipidemias , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipolipemiantes/uso terapéutico , Dislipidemias/diagnóstico , Dislipidemias/tratamiento farmacológico , LDL-Colesterol , Factores de RiesgoRESUMEN
The risk of atherosclerotic cardiovascular disease (ASCVD) is strongly related to lifetime exposure to low-density lipoprotein (LDL)-cholesterol in longitudinal studies. Lipid-lowering therapy (using statins, ezetimibe and PCSK9 inhibitors) substantially ameliorates the risk and is associated with long-term reduction in cardiovascular (CV) events. The robust evidence supporting these therapies supports their continued (and expanding) role in risk reduction. In addition to these 'conventional' therapeutics, while waiting for other innovative therapies, growing evidence supports the use of a range of 'nutraceuticals' (constituents of food prepared as pharmaceutical formulations) including preparations of red yeast rice (RYR), the product of yeast (Monascus purpureus) grown on rice, which is a constituent of food and is used in traditional Chinese medicine. The major active ingredient, monacolin K, is chemically identical to lovastatin. RYR preparations have been demonstrated to be safe and effective in reducing LDL-C, and CV events. However, surprisingly, RYR has received relatively little attention in international guidelines - and conventional drugs with the strongest evidence for event reduction should always be preferred in clinical practice. Nevertheless, the absence of recommendations relating to RYR may preclude the use of a product which may have clinical utility in particular groups of patients (who may anyway self-prescribe this product), what in the consequence might help to reduce population CV risk. This Position Paper of the International Lipid Expert Panel (ILEP) will use the best available evidence to give advice on the use of red-yeast rice in clinical practice.
Asunto(s)
Anticolesterolemiantes , Productos Biológicos , Enfermedades Cardiovasculares , Dislipidemias , Anticolesterolemiantes/uso terapéutico , Productos Biológicos/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/prevención & control , Colesterol , Dislipidemias/tratamiento farmacológico , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Lovastatina/uso terapéutico , Proproteína Convertasa 9 , Factores de Riesgo , Conducta de Reducción del RiesgoRESUMEN
BACKGROUND: Obesity and its health consequences will dominate health care systems in many countries during the next decades. However, the body mass index (BMI) optimum in relation to all-cause mortality is still a matter of debate. MATERIAL AND METHODS: Data of the Vorarlberg Health Monitoring & Prevention Program (VHM&PP, 1985-2005) and data provided by the Main Association of Austrian Social Security Institutions (MAASSI, 2005-2015) were analyzed. Information was available on age, sex, smoking status, measured height and weight, and mortality. Generalized additive models were used to model mortality as a function of BMI, calendar time, age, and follow-up. RESULTS: In MAASSI (N = 282,216, 46.0% men), men and women were on average 2.7 years older than in VHM&PP (N = 185,361, 46.1% men). Average BMI was slightly higher in men (26.1 vs 25.7 kg/m2) but not in women (24.6 vs 24.7 kg/m2). We found an interactive effect of age and follow-up on the BMI optimum. Over age 35 years in men and 55 years in women, the BMI optimum decreased with length of follow-up. While keeping covariates fixed, BMI optimum increased slightly between 1985 and 2015 in men and women, 24.9 (95% CI, 23.9-25.9) to 26.4 (95% CI, 25.3-27.3), and 22.4 (95% CI, 21.7-23.1) to 23.3 (95% CI, 22.6-24.5) kg/m2, respectively. CONCLUSION: Age and length of follow-up have a pronounced effect on the BMI associated with the lowest all-cause mortality. After controlling for age and length of follow-up, the BMI optimum increased slightly over 30 years in this large study sample.
Asunto(s)
Obesidad , Adulto , Austria/epidemiología , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Obesidad/epidemiología , Factores de RiesgoRESUMEN
The availability of efficient lipid-lowering drugs has substantially reduced the incidence and mortality for cardiovascular disease (CVD). Despite that, CVD still represents a major cause of death and disability; efforts are thus required to prevent this disease, since reducing the established CV risk factors may slow or prevent the onset of cardiovascular events. Current guidelines recommend a healthier lifestyle for all CV risk categories, as it may have a beneficial impact on several risk factors; in individuals with a low-to-moderate hypercholesterolemia, which are not eligible for a pharmacological approach and are not far from the cholesterol target recommended for their risk category, functional foods or nutraceuticals may be considered as supplement to reduce their CV risk status. Of note, counseling and lifestyle intervention in people at moderate CV risk represents a major issue for both preventing a further risk increase and reducing the need for drugs. Studies on general populations have clearly indicated that lifestyle interventions translate into a clinical benefit, with reduction of the incidence of myocardial infarction and the risk of developing type 2 diabetes.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Hipercolesterolemia/terapia , Consejo , Dieta , Suplementos Dietéticos , Ejercicio Físico , Humanos , Estilo de Vida , Conducta de Reducción del Riesgo , Pérdida de PesoRESUMEN
Elevated blood pressure remains a major cause of cardiovascular disease, disability, and premature death in Austria, with suboptimal rates of detection, treatment and control also in recent years. Management of hypertension is a common challenge for physicians with different spezializations. In an attempt to standardize diagnostic and therapeutic strategies and, ultimately, to increase the rate of patients with controlled blood pressure and to decrease the burden of cardiovascular disease, 13 Austrian medical societies reviewed the evidence regarding prevention, detection, workup, treatment and consequences of high blood pressure in general and in various clinical scenarios. The result is presented as the first national consensus on blood pressure. The authors and societies involved are convinced that a joint national effort is needed to decrease hypertension-related morbidity and mortality in our country.
Asunto(s)
Antihipertensivos , Enfermedades Cardiovasculares , Hipertensión , Antihipertensivos/uso terapéutico , Austria , Presión Sanguínea , Enfermedades Cardiovasculares/prevención & control , Consenso , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológicoAsunto(s)
Productos Biológicos/uso terapéutico , Suplementos Dietéticos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/terapia , Productos Biológicos/efectos adversos , Productos Biológicos/farmacocinética , Biotransformación , Enfermedades Cardiovasculares/inducido químicamente , Colesterol/sangre , Ensayos Clínicos como Asunto , Citocromo P-450 CYP3A/metabolismo , Método Doble Ciego , Testimonio de Experto , Interacciones Alimento-Droga , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Lovastatina/efectos adversos , Lovastatina/química , Lovastatina/farmacocinética , Lovastatina/uso terapéutico , Medicina Tradicional China , Estructura Molecular , Estudios Multicéntricos como Asunto , Enfermedades Musculoesqueléticas/inducido químicamente , Profármacos/farmacocinética , Profármacos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , AutomedicaciónRESUMEN
The present article is a recommendation of the Austrian Diabetes Association for the practical use of insulin in type 2 diabetes, including the various insulin regimens.
Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Guías de Práctica Clínica como Asunto , Austria , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Esquema de Medicación , HumanosRESUMEN
Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.
Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2 , Hipoglucemiantes/uso terapéutico , Guías de Práctica Clínica como Asunto , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hiperglucemia/tratamiento farmacológico , Estilo de VidaRESUMEN
Hyper- and dyslipidemia contribute to cardiovascular morbidity and mortality in diabetic patients. Pharmacological therapy to lower LDL cholesterol has convincingly shown to reduce cardiovascular risk in diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the use of lipid-lowering drugs in diabetic patients according to current scientific evidence.