Therapy potential for the correction of cardiovascular disturbances in diabetes mellitus
https://doi.org/10.15829/1728-8800-2012-4-59-64
Abstract
Aim. To study the dynamics of left ventricular (LV) structure and function, as well as vasomotor activity of arterial endothelium, in patients with Type 2 diabetes mellitus (DM-2) and diastolic heart failure (DHF) who are treated with an angiotensin II receptor antagonist olmesartan.
Material and methods. The study included 56 patients (26 men and 30 women; mean age 58,2±5,3 years) with NYHA Functional Class I-II chronic heart failure (CHF), diastolic LV dysfunction (abnormal relaxation), and LV ejection fraction (EF) >50%. Other inclusion criteria were DM-2 duration <15 years and per os glucoselowering treatment.
Results. The major pathogenetic mechanisms of LV diastolic dysfunction and endothelial dysfunction in DM-2 are linked to the development of central sympathetic hyperactivation and activation of the tissue reninangiotensin system.
Conclusion. After 30 weeks of olmesartan therapy, LV structure and geometry, LV diastolic function, and vasomotor activity of arterial endothelium had improved, which was expected to reduce the risk of myocardial ischemia.
About the Authors
I. P. Tatarchenko
Penza Institute of Medical Post-diploma Education
Russian Federation
Russian Federation
N. V. Pozdnyakova
Penza Institute of Medical Post-diploma Education; Medical Centre No. 59, Federal Medical and Biological Agency, Penza
Russian Federation
Russian Federation
A. G. Mordovina
Penza Institute of Medical Post-diploma Education; Medical Centre No. 59, Federal Medical and Biological Agency, Penza
Russian Federation
Russian Federation
O. I. Morozova
Penza Institute of Medical Post-diploma Education
Russian Federation
Russian Federation
E. V. Rubleva
Penza Institute of Medical Post-diploma Education
Russian Federation
Russian Federation
References
1. Zimmet P, Shaw J, Alberti G. Preventing type 2 diabetes and the dysmetabolic syndrome in the real world: a realistic view. Diabetic medicine 2003; 20(9):693-702.
2. Basta G, Del Turco S, De Caterina R. Advanced glycation endproducts: implications for accelerated atherosclerosis in diabetes. Recenti Prog Med 2004; 95: 67-80.
3. Dedov EE, Shestakova MV. Diabetes mellitus and arterial hypertension. M.: Medical informational Agency; 2006. Russian (Дедов И.И., Шестакова М.В. Сахарный диабет и артериальная гипертензия. М.: Медицинское информационное агентство 2006).
4. Shlyakhto EV, Schwartz EI, Nefedova UB, et al. Diastolic dysfunction in hypertensive patients: prevalence, hemodynamic, demographic and genetic determinants. Heart Failure 2003; 4: 187-9. Russian (Шляхто Е.В., Шварц Е.И., Нефедова Ю.Б. и др. Диастолическая дисфункция у больных гипертонической болезнью: распространенность, гемодинамические, демографические и генетические детерминанты. Сердечная недостаточность 2003; 4: 187-9).
5. Grewal J, McCully RB, Kane GC, et al. Left ventricular function and exercise capacity. JAMA 2009; 301: 286-94.
6. Lee PW, Zhang Q, Yip GW, et al. Left ventricular systolic and diastolic dyssynchrony in coronary artery disease with preserved ejection fraction. Clin Sci (Lond) 2009; 116: 521–9.
7. Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. JACC 1992; 19: 1550-8.
8. Celermajer DS, Sorensen KE, Gooch VM, et al. Non–invasive deteсtion of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340: 1111–5.
9. Velliquette RA, Ernsberger P. Contrasting metabolic effects of antihypertensive agents. J Pharmacol Exp Ther 2003; 307:1104-11.
10. Tatarchenko IP, Pozdnyakova NV, Mordovina AG, Morozova OI. Dysfunction of vascular endothelium in the evaluation of episodes of myocardial ischemia in type 2 diabetes. Problems of Endocrin 2009; 6: 7-11. Russian (Татарченко И.П., Позднякова Н.В., Мордовина А.Г., Морозова О.И. Дисфункция сосудистого эндотелия в оценке эпизодов ишемии миокарда при сахарном диабете 2 типа. Проблемы эндокринологии 2009; 6: 7-11).
11. Dedov EE, Aleksandrov AA. Diabetes mellitus and AT1-receptor antagonists: in search of solution. Rus J Med 2005; 11: 11-6. Russian (Дедов И.И., Александров А.А. Сахарный диабет и антагонисты АТ1- рецепторов: в поисках золотого ключика. Русский медицинский журнал 2005; 11: 11-6).
12. Ohara T, Little WC. Evolving focus on diastolic dysfunction in patients with coronary artery disease. Curr Opin Cardiol 2010; 25(6): 613-21.
13. Paulus WJ. Novel strategies in diastolic heart failure. Heart 2010; 96(14): 1147-53.
14. Scheen AJ. Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 1. A meta-analysis of randomized clinical trials. Diabetes Metab 2004; 30: 487-96.
15. Brown B, Hall A. Renin-angiotensin system: the weight of evidence. Am J Hypertens 2005; 18: 127S-33.
Review
For citations:
Tatarchenko I.P., Pozdnyakova N.V., Mordovina A.G., Morozova O.I., Rubleva E.V. Therapy potential for the correction of cardiovascular disturbances in diabetes mellitus. Cardiovascular Therapy and Prevention. 2012;11(4):59-64. (In Russ.) https://doi.org/10.15829/1728-8800-2012-4-59-64
Views:
465
Email this article 
