C-reaktivni protein i kardiovaskularni rizik u starih osoba sa dijabetes mellitus-om tip 2

Abstract

U Srbiji, kao i u razvijenim zemljama, dijabetes je peti uzrok opterećenja bolešću. Osobe sa dijabetesom tip 2 su mnogobrojnije (95%) u poređenju sa obolelima od dijabetesa tip 1. Procenjuje se da je skoro polovina obolelih od dijabetesa tip 2 starija od 65 godina. Za obolele od dijabetesa se smatra da imaju isti kardiovaskularni rizik kao oboleli od kardiovaskularnih bolesti. Kardiovaskularni mortalitet je vodeći uzrok smrti u starih. Već je poznato da tradicionalni kardiovaskularni faktori rizika nisu glavni prediktori kardiovaskularnih događaja u starih. Studije su pokazale da neki od ovih faktora rizika čak imaju suprotno dejstvo u najstarijih starih (≥85 godina). Starenje je udruženo sa aktiviranjem čitave inflamatorne kaskade. Inflamatorni markeri kao C-reaktivni protein (CRP), interleukin-6 i fibrinogen su udruženi sa kardiovaskularnim mortalitetom. Moguće je da su biomarkeri inflamacije jače povezani sa vaskularnim rizikom u starih, nego lipidni status ili drugi tadicionalni faktori rizika. Inflamacija i hiperglikemija doprinose razvoju i progresiji ateroskleroze i često se nalaze u pacijenata sa klinički uznapredovalom bolešću. Uzimajući u obzir vezu inflamacije, hiperglikemije i ateroskleroze, pretpostavili smo da povećan CRP i glikozilirani hemoglobin (HbA1c) zajedno doprinose kardiovaskularnom riziku u pacijenata sa dijabetesom tip 2 i klinički uznapredovalom aterosklerozom. CILJ RADA Cilj rada bio je da se ispita značaj CRP kao prediktora glavnih kardiovaskularnih događaja (major cardiovascular events - MACE) u starih sa dijabetesom tip 2 (T2D)...

In Serbia, as in developed countries, diabetes is the fifth cause of burden of disease. Persons with type 2 diabetes are numerous (95%) compared to those with type 1 diabetes. It is estimated that nearly half of patients with type 2 diabetes are over the age of 65 years. Diabetes is considered to carry the same cardiovascular risk as previous cardiovascular disease. Cardiovascular mortality is the leading cause of death in elderly people. It’s already known that traditional cardiovascular risk factors are not principal predictors for cardiovascular events in the elderly. Studies have shown that some of these risk factors even act in reverse direction with the oldest people (≥85 years). Aging is associated with activation of the entire inflammatory cascade. Inflammatory markers such as C-reactive protein, interleukin 6 and fibrinogen are all positively correlated with cardiovascular death. It is possible that biomarkers of inflammation are more strongly related to vascular risk in aged people than measures of plasma lipids, or others established risk factors. The inflammation and hyperglycemia contribute to the development and progression of atherosclerosis and are often found in patients with clinically advanced disease. Taking into account the interplay between inflammation, hyperglycemia and atherosclerosis, we assumed that elevated CRP and glycosylated hemoglobin (HbA1c) all contribute to cardiovascular risk in patients with type 2 diabetes and clinically advanced atherosclerosis. OBJECTIVE Objective of this study is to examine the importance of CRP as a predictor of major cardiovascular events (MACE) in the elderly with type 2 diabetes. METHODS PhD thesis was done at the Institute of Gerontology and Palliative Care, Belgrade. It was a prospective study with 32 months follow-up period. Participants of the study were 253 community dwelling elderly aged 65 to 99 years...