Cardiovascular disease, which includes coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD), is the leading cause of mortality in populations, particularly in the diabetic one. Individuals with diabetes have at least a two-fold to four-fold increased risk of having cardiovascular events and a double risk of death compared with age-matched subjects without diabetes. A decline in mortality from CVD has been shown, but decline due to CHD is consistently lower in individuals with diabetes when compared with non-diabetics. The presence of several factors in diabetes leads to high occurrence of CVD such as hyperglycemia, insulin resistance, and classical and non-classical risk factors (systemic hypertension, dyslipidemia, obesity, proinflammatory condition and others). It is possible that the atherogenic role of obesity may be at least in part due to increased adipocyte production of cytokines. Considering the marked association of diabetes and CVD and unfavorable prognosis following an event, it is important to identify who is at high risk and how to screen. The American Heart Association and American Diabetes Association recommend risk stratification using diagnostic tests. However, the challenge is to accurately identify patients without a prior history of an event and those without symptoms strongly suggesting CVD, in whom additional testing would be indicated in order to achieve the most effective prevention. The benefits of glycemic control and the other risk factors have already been shown and justify optimization of the management of this high-risk population, aiming to reduce cardiovascular mortality disease and improve quality of life.
The dyslipidemia of the metabolic syndrome (MS) confers an elevated cardiovascular risk and is characterized by increased concentrations of triglycerides, decreased HDL-cholesterol and qualitative alterations in LDL which renders it more atherogenic, like the small dense LDL. Modified forms of LDL (mLDL) have been detected in vivo in the plasma and atherosclerotic plaques. A minor fraction of the total LDL has an electronegative charge and is represented by a heterogenic subpopulation of particles [LDL(-)], with higher potential to induce endothelial injury. It could be derived from oxidation, glication or other processes that alter its chemical composition and is increased in diabetic, hypercholesterolemic subjects, and in those with established coronary artery disease. mLDL are internalized by macrophages through scavenger receptors, originating foam cells and inducing an immune-inflammatory reaction. In the atherosclerotic process, the action of mLDL continues until plaque rupture and thrombogenesis, when it promotes apoptosis in endothelial and smooth muscle cells, and activates matrix metalloproteinases, weaken the fibrous cap, and further enhance the inflammatory process that ends in the thrombus formation. Development of new laboratory methods is necessary to enhance the clinical applicability of mLDL and the predictive power of the conventional lipid profile and other cardiovascular risk factors of the MS.
RESUMOA crescente prevalência de diabetes mellitus (DM) em países em desenvolvimento, associada à facilidade de se identificar indivíduos de alto risco para a doença, tornam interessante a idéia de se introduzir medidas que visem à prevenção da doença. Vários estudos comprovam os benefícios de mudanças no estilo de vida em prevenir ou retardar a progressão da tolerância à glicose diminuída para o DM. A revisão destes estudos mostra que é possível reduzir em 50 a 60% a incidência de DM intervindo-se no estilo de vida destes indivíduos, resultado superior ao obtido naqueles que, até o momento, utilizaram medidas farmacológi-cas com o mesmo objetivo. Apesar da eficácia destas simples medidas de prevenção por meio de mudanças no estilo de vida, estas são de difícil aderência e implementação em comunidades. Em nosso meio, são necessários estudos para avaliar as dificuldades de se implantar um programa nacional de prevenção de DM e outras doenças relacionadas ao estilo de vida em brasileiros de alto risco. Considering the increasing prevalence of diabetes mellitus (DM) in underdeveloped countries as well as the simplicity of identifying individuals at high risk for such disease, implementation of intervention measures for its prevention is of great interest. Several studies have confirmed the benefits of lifestyle changes in preventing or postponig the progression from impaired glucose tolerance to DM. The review of these studies showed a 50% to 60% reduction in the incidence of DM by means of lifestyle modifications. Such results are better than those reported in studies in which pharmacological interventions were used with the same purpose. Despite the efficacy of lifestyle changes for the prevention of DM, compliance may represent a limitation to be implemented in communities. In our country, studies are necessary to assess the barriers for the implementation of a population-based program for the prevention of DM and other lifestyle related diseases in high-risk Brazilian subjects.
RESUMOAlta prevalência de diabetes em população nipo-brasileira de Bauru/SP foi previamente relatada. Visando a complementar a avaliação do risco cardiometabólico, este estudo analisou distúrbios no perfil lipídico de 1.330 nipobrasileiros (46% homens) > 30 anos. Definiu-se hipercolesterolemia por níveis de colesterol total 240 mg/dL; hipertrigliceridemia por valores 150 mg/dL e HDL-colesterol baixo por valores < 40 mg/dL e < 50 mg/dL para homens e mulheres, respectivamente. A prevalência desses distúrbios foi comparada pelo qui-quadrado, estratificando-se por sexos e categorias glicêmicas. As médias dos lipídeos e lipoproteínas foram comparadas entre sexos pelo teste t de Student. A prevalência de hipertrigliceridemia foi de 66,0% (IC95%:63,5 -68,5%), sendo mais comum em homens e aumentando com a piora da categoria glicêmica; a trigliceridemia média foi 235,7 ± 196,3 mg/dL. A prevalência de hipercolesterolemia foi 24,4% (IC95%:22,1 -26,7%); HDL-C baixo foi observado em 43,0% (IC95%:39,4 -46,6%] das mulheres e 17,5% (IC95%:14,5 -20,5%) dos homens, porém a razão colesterol total/HDL-C foi menor em mulheres
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