2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(39), P. 4043 - 4140

Published: Aug. 25, 2023

The ESC Guidelines represent the views of and were produced after careful consideration scientific medical knowledge evidence available at time their publication.The is not responsible in event any contradiction, discrepancy, and/or ambiguity between other official recommendations or guidelines issued by relevant public health authorities, particular relation to good use healthcare therapeutic strategies.Health professionals are encouraged take fully into account when exercising clinical judgment, as well determination implementation preventive, diagnostic strategies; however, do override, way whatsoever, individual responsibility make appropriate accurate decisions each patient's condition consultation with that patient and, where necessary, caregiver.Nor exempt from taking full updated competent order manage case light scientifically accepted data pursuant respective ethical professional obligations.It also professional's verify applicable rules regulations relating drugs devices prescription.

Language: Английский

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Inflammation and atherosclerosis: signaling pathways and therapeutic intervention

Signal Transduction and Targeted Therapy, Journal Year: 2022, Volume and Issue: 7(1)

Published: April 22, 2022

Atherosclerosis is a chronic inflammatory vascular disease driven by traditional and nontraditional risk factors. Genome-wide association combined with clonal lineage tracing clinical trials have demonstrated that innate adaptive immune responses can promote or quell atherosclerosis. Several signaling pathways, are associated the response, been implicated within atherosclerosis such as NLRP3 inflammasome, toll-like receptors, proprotein convertase subtilisin/kexin type 9, Notch Wnt which of importance for development regression. Targeting especially inflammasome pathway its regulated cytokine interleukin-1β, could represent an attractive new route treatment atherosclerotic diseases. Herein, we summarize knowledge on cellular participants key pathways in atherosclerosis, discuss preclinical studies targeting these going to target some processes, effects quelling inflammation clinic.

Language: Английский

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Randomised clinical trial: Pemafibrate, a novel selective peroxisome proliferator‐activated receptor α modulator (SPPARMα), versus placebo in patients with non‐alcoholic fatty liver disease

Alimentary Pharmacology & Therapeutics, Journal Year: 2021, Volume and Issue: 54(10), P. 1263 - 1277

Published: Sept. 16, 2021

Summary Background Pemafibrate is a novel, selective peroxisome proliferator‐activated receptor α modulator (SPPARMα). In mice, improved the histological features of non‐alcoholic steatohepatitis (NASH). patients with dyslipidaemia, it serum alanine aminotransferase (ALT). Aims To evaluate efficacy and safety in high‐risk, fatty liver disease (NAFLD). Methods This double‐blind, placebo‐controlled, randomised multicentre, phase 2 trial 118 (1:1) to either 0.2 mg or placebo, orally, twice daily for 72 weeks. The key inclusion criteria included fat content ≥10% by magnetic resonance imaging‐estimated proton density fraction (MRI‐PDFF); stiffness ≥2.5 kPa, elastography (MRE); elevated ALT levels. primary endpoint was percentage change MRI‐PDFF from baseline week 24. secondary endpoints MRE‐based stiffness, ALT, fibrosis markers lipid parameters. Results There no significant difference between groups (−5.3% vs −4.2%; treatment −1.0%, P = 0.85). However, significantly decreased compared placebo at 48 (treatment −5.7%, 0.036), maintained −6.2%, 0.024), reduction LDL‐C. Adverse events were comparable therapy well tolerated. Conclusions did not decrease but had stiffness. may be promising therapeutic agent NAFLD/NASH, also candidate combination agents that reduce content. ClinicalTrials.gov, number: NCT03350165.

Language: Английский

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Nonalcoholic fatty liver disease as a metabolic disease in humans: A literature review

Diabetes Obesity and Metabolism, Journal Year: 2021, Volume and Issue: 23(5), P. 1069 - 1083

Published: Jan. 19, 2021

Abstract Aims To conduct a systematic literature review to identify recent epidemiological, biomarker, genetic and clinical evidence that expands our understanding of nonalcoholic fatty liver disease (NAFLD) as metabolic disorder. Materials Methods We performed search using PubMed trials, observational studies meta‐analyses published in the past 5 years. Results A total 95 publications met prespecified inclusion criteria reported on interplay between NAFLD/nonalcoholic steatohepatitis (NASH) dysfunction, terms burden and/or epidemiology (n = 10), pathophysiology, risk factors associated conditions 29), diagnosis biomarkers 34), treatment approaches 22). There is growing body links NAFLD/NASH pathogenesis mechanisms through lipid accumulation, insulin resistance, inflammation, apoptosis, fibrogenic remodelling within liver. The frequent co‐occurrence NAFLD with obesity, syndrome type 2 diabetes supports this premise. Therapeutic originally envisaged for or obesity (such glucagon‐like peptide‐1 receptor agonists, sodium‐glucose co‐transporter‐2 inhibitors, sensitizers bariatric surgery) have shown promising signs benefit patients NAFLD/NASH. Conclusions Given complex there an urgent need multidisciplinary collaboration established protocols care are individualized ideally support reduction overall well NASH.

Language: Английский

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Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease

International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(3), P. 2844 - 2844

Published: Feb. 2, 2023

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic that affects approximately one-quarter of global adult population, posing a significant threat to human health with wide-ranging social and economic implications. The main characteristic NAFLD considered excessive fat accumulated deposited in hepatocytes without excess alcohol intake or some other pathological causes. progressive disease, ranging from steatosis non-alcoholic steatohepatitis (NASH), cirrhosis, hepatocellular carcinoma, transplantation, death. Therefore, will probably emerge as leading cause end-stage coming decades. Unlike highly diseases, has received little attention public community. Liver biopsy currently gold standard for diagnosis staging because absence noninvasive specific biomarkers. Due complex pathophysiological mechanisms heterogeneity phenotype, no pharmacological therapies have been approved at present, although several drugs are advanced stages development. This review summarizes current evidence on pathogenesis, treatment NAFLD.

Language: Английский

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Lactiplantibacillus plantarum A5 alleviates high-fat diet-induced hyperlipidemia via regulating gut microbiota to promote short-chain fatty acids production

Food Bioscience, Journal Year: 2025, Volume and Issue: unknown, P. 105848 - 105848

Published: Jan. 1, 2025

Language: Английский

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Impact of peroxisome proliferator-activated receptor-α on diabetic cardiomyopathy

Cardiovascular Diabetology, Journal Year: 2021, Volume and Issue: 20(1)

Published: Jan. 4, 2021

Abstract The prevalence of cardiomyopathy is higher in diabetic patients than those without diabetes. Diabetic (DCM) defined as a clinical condition abnormal myocardial structure and performance other cardiac risk factors, such coronary artery disease, hypertension, significant valvular disease. Multiple molecular events contribute to the development DCM, which include alterations energy metabolism (fatty acid, glucose, ketone branched chain amino acids) abnormalities subcellular components heart, impaired insulin signaling, increased oxidative stress, calcium mishandling inflammation. There are no specific drugs treating DCM despite decades basic investigations. This is, part, due lack our understanding how heart failure initiates develops, especially an underlying ischemic cause. Some traditional anti-diabetic or lipid-lowering agents aimed at shifting balance from utilizing fat glucose have been shown inadequately targeting multiple aspects conditions. Peroxisome proliferator-activated receptor α (PPARα), transcription factor, plays important role mediating DCM-related events. Pharmacological PPARα activation has demonstrated be one strategies for with diabetes, metabolic syndrome, atherosclerotic cardiovascular diseases. aim this review provide contemporary view association pathophysiological changes DCM. We discuss PPARα-related applications facts related that may considered risky (such fenofibrate, bezafibrate, clofibrate) safe (pemafibrate, metformin glucagon-like peptide 1-receptor agonists) having potential (sodium–glucose co-transporter 2 inhibitor)

Language: Английский

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Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy

Journal of Clinical Medicine, Journal Year: 2021, Volume and Issue: 10(20), P. 4666 - 4666

Published: Oct. 12, 2021

Diabetic retinopathy (DR) is a complication of diabetes and one the leading causes vision loss worldwide. Despite extensive efforts to reduce visual impairment, prevalence DR still increasing. The initial pathophysiology includes damage vascular endothelial cells pericytes. Ensuing hypoxic responses trigger expression growth factor (VEGF) other pro-angiogenic factors. At present, most effective treatment for diabetic macular edema (DME) control blood glucose levels. More advanced cases require laser, anti-VEGF therapy, steroid, vitrectomy. Pan-retinal photocoagulation non-proliferative (NPDR) well established has demonstrated promising outcomes preventing progressive stage DR. Furthermore, efficacy laser therapies such as grid subthreshold diode micropulse (SDM) DME been reported. Vitrectomy performed vitreous hemorrhage tractional retinal detachment patients with PDR. In addition, widely used DME, recently its potential prevent progression PDR remarked. Even these treatments, many lose their suffer from side effects. Thus, we need alternative treatments address limitations. recent years, relationship between DR, lipid metabolism, inflammation featured. Research in animal models points peroxisome proliferator-activated receptor alpha (PPARα) activation cellular metabolism by oral fenofibrate and/or pemafibrate target this paper, review status existing therapies, summarize PPARα discuss potentials treatments.

Language: Английский

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Lipid Lowering Drugs: Present Status and Future Developments

Current Atherosclerosis Reports, Journal Year: 2021, Volume and Issue: 23(5)

Published: March 10, 2021

Abstract Purpose of review Based on the recent data DA VINCI study, it is clear that, besides utilization statins, there a need to increase non-statin lipid lowering approaches reduce cardiovascular burden in patients at highest risk. Recent findings For hypercholesterolemia, small synthetic molecule bempedoic acid has added benefit selective liver activation, whereas inclisiran, hepatic inhibitor PCSK9 synthesis, comparable effects with monoclonal antibodies. hypertriglyceridemia, been achieved by use icosapent ethyl, results pemafibrate, agonist PPAR-α, are eagerly awaited. In era RNA-based therapies, new options offered dramatically levels lipoprotein(a) (APO(a)L RX ) and triglycerides (ANGPTL3L APOCIII-L Rx ). Summary Despite demonstrated benefits large number still remain significant risk because inadequate LDL-C reduction or elevated blood triglyceride-rich lipoproteins lipoprotein(a). The area modulating agents ripe ideas major novelties be awaited next few years.

Language: Английский

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Small, Dense Low-Density Lipoprotein-Cholesterol and Atherosclerosis: Relationship and Therapeutic Strategies

Frontiers in Cardiovascular Medicine, Journal Year: 2022, Volume and Issue: 8

Published: Feb. 10, 2022

Low-density lipoprotein cholesterol (LDL-C) plays an important role in the formation, incidence, and development of atherosclerosis (AS). lipoproteins can be divided into two categories: large light LDL-C small, dense low-density (sdLDL-C). In recent years, increasing number studies have shown that sdLDL-C has a strong ability to cause AS because its unique characteristics, such as having small-sized particles low density. Therefore, this become focus further research. However, specific mechanisms regarding involvement not been fully explained. This paper reviews possible by reviewing relevant literature years. It was found increase atherogenic effect regulating activity gene networks, monocytes, enzymes. article also research progress on effects endothelial function, lipid metabolism, inflammation; it discusses intervention effect. Diet, exercise, other non-drug interventions improve levels. Further, drug statins, fibrates, ezetimibe, niacin

Language: Английский

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