In medical practice, there are often patients who have several diseases at once, both pathogenetically related to each other and not related. The article discusses endocrine diseases in which there are manifestations from the cardiovascular system - disorders of carbohydrate metabolism, pathology of the thyroid gland, adrenal glands and acromegaly. These diseases reduce the quality of life of patients and increase the risks of cardiovascular complications. The article also discusses the features of cardiovascular manifestations in these diseases and indications for differential diagnosis. Type 2 diabetes mellitus significantly increases the cardiovascular risks, which leads to a more rapid progression of atherosclerosis. Moreover, vascular disorders are detected already at the stage of prediabetes. Therefore, it is necessary to identify disorders of carbohydrate metabolism as early as possible and initiate appropriate therapy. When prescribing antihyperglycemic therapy, preference should be given to drugs with a low risk of hypoglycemia (metformin, glucagon-like peptide-1 agonists, type 2 sodium glucose co-transporter inhibitors). Thyroid dysfunctions - thyrotoxicosis and hypothyroidism - also have an adverse effect on the cardiovascular system. Hypothyroidism often has a blurred clinical picture and manifestations from various organs, and therefore it is diagnosed late. Therefore, an active diagnosis of this condition should be carried out in persons with a combination of a wide variety of diseases, especially in old age. Adrenal pathology (pheochromocytoma, hyperaldosteronism and hypercorticism) is manifested by an increase in blood pressure. Differential diagnosis is worthwhile in case of severe arterial hypertension or resistance to antihypertensive therapy. In acromegaly, lesions of the cardiovascular system are quite common and are the main cause of death in these patients. Therefore, early detection of this pathology is especially important. Thus, such patients should be monitored jointly by a cardiologist and an endocrinologist, and timely diagnosis and treatment of endocrine pathology will help reduce their cardiovascular risks.
The objective of the Program is to estimate the efficacy and safety of insulin glargine (Lantus) used in routine clinical practice for the treatment of patients presenting with type 2 diabetes mellitus who failed to reach adequate compensation of the disease by therapy with two hyperglycemic agents in combination with NPH insulin and have a glycated hemoglobin level in excess of 7.0%. The data obtained by examining 2395 patients (755 men and 1640 women) were available for analysis. 2157 patients (685 men and 1472 women) were transferred to insulin glargine therapy whereas the remaining 238 ones (70 men and 168 women) continued to use NPH insulin. The patients of the former group were offered two algorithms for dose titration of glargine (Lantus). Significant improvement of the parameters of carbohydrate metabolism was achieved within 12 weeks after the onset of therapy without the risk of hypoglycemia. It is concluded that the results of the Program demonstrate a higher efficacy and safety of insulin glargine compared with NPH insulin for the treatment of the patients with type 2 diabetes mellitus. The use of a simple dose titration algorithm and glycemic self-control makes it possible to quickly, safely, and efficiently achieve optimal parameters of carbohydrate metabolism in the majority of the patients treated with insulin glargine at a low incidence of episodes of all types of hypoglycemia.
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