Background:
During the past decades, the prevalence of diabetes (DM) has increased significantly,
mainly as a result of continuous rise in the incidence of type 2 DM. According to World Health
Organization statistics, >422 million adults globally were suffering from DM in 2014 and a continuous
rise in DM prevalence is expected.
Objective:
The present review considers recent epidemiological data providing worldwide estimates
regarding the incidence of DM.
Methods:
A comprehensive literature search was conducted to identify available data from epidemiological
studies evaluating the current burden of DM.
Results:
Over the past few decades the prevalence of DM has risen significantly in nearly all countries
and may be considered as a growing epidemic. Urbanization and income status are major factors which
influence current rates in the prevalence studies introducing interesting differences between several
population groups.
Conclusion:
Having recognized the global burden of DM, we now realize the urgent need for effective
interventions. In order to monitor the public-health strategies and design effective future interventions
we need reliable global estimates regarding the prevalence of DM.
Background:
Cardiovascular disease (CVD) still remains the leading cause of morbidity and mortality worldwide. It is now established that inflammation plays a crucial role in atherosclerosis and atherothrombosis, and thus, it is closely linked to cardiovascular disease.
Objective:
The aim of the present review is to summarize and critically appraise the most relevant evidence regarding the potential use of inflammatory markers in the field of CVD.
Method:
We conducted a comprehensive research of the relevant literature, searching MEDLINE from its inception until November 2018, primarily for meta-analyses, randomized controlled trials and observational studies.
Results:
Established markers of inflammation, mainly C-reactive protein, have yielded significant results both for primary and secondary prevention of CVD. Newer markers, such as lipoprotein-associated phospholipase A2, lectin-like oxidized low-density lipoprotein receptor-1, cytokines, myeloperoxidase, cell adhesion molecules, matrix metalloproteinases, and the CD40/CD40 ligand system, have been largely evaluated in human studies, enrolling both individuals from the general population and patients with established CVD. Some markers have yielded conflicting results; however, other are now recognized not only as promising biomarkers of CVD, but also as potential therapeutic targets, establishing the role of anti-inflammatory and pleiotropic drugs in CVD.
Conclusion:
There is significant evidence regarding the role of consolidated and novel inflammatory markers in the field of diagnosis and prognosis of CVD. However, multimarker model assessment, validation of cut-off values and cost-effectiveness analyses are required, in order for those markers to be integrated into daily clinical practice.
Background:
Low-density Lipoprotein Cholesterol (LDL-C) is a major Cardiovascular (CV) risk
factor. Accumulating evidence supports a linear association between LDL-C levels and CV risk. However, the
lower limit of LDL-C that might offer CV benefits without any safety concerns is still a topic of debate.
Objective:
The purpose of this review is to present the safety of reducing LDL-C to low levels as it comes from
major lipid-lowering drug studies, and to discuss data on several safety events that have been associated with low
LDL-C levels.
Methods:
A comprehensive literature search was performed to identify available data from clinical studies evaluating
the association of low LDL-C with safety outcomes.
Results:
Several large trials have evaluated the safety or reducing LDL-C to levels lower than 50 mg/dl or even
lower than 25 mg/dl, more commonly with the use of a combination of statins with ezetimibe or proprotein convertase
subtilisin kexin 9 inhibitors. In almost all trials, CV benefits were observed with LDL-C levels of 50
mg/dl or less compared with higher levels. In terms of safety, reduction of LDL-C to such levels was not associated
with any significant adverse event. Of importance, cancer and hemorrhagic stroke incidences were not increased
in patients attaining LDL-C lower than 40-50 mg/dl. Data regarding the impact of lowering LDL-C with
neurocognitive disorders are contradictory; nevertheless, most studies stand in favor of neurocognitive safety with
LDL-C reductions to low levels.
Conclusion:
Achieving an LDL-C of 40-50 mg/dl seems to be safe, and importantly might offer CV beneficial
effects. Data for attaining levels below 25 mg/dl is limited, however in favor of such reductions.
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