Pathogenetic Mechanisms and Ways of Preventing Cardiovascular Complications of Diabetes Mellitus Type 2

Type 2 Diabetes Mellitus (hereinafter – DM 2) is the most common endocrine disorder, and its prevalence in Europe, the USA and Canada is 8% of the total adult population. The incidence of DM 2 in the world is increasing every year, and real growth rates outperform all forecasts. In 2009 it was expected that by 2025 the number of patients with DM 2 in the world will reach 380 million. However, there are 380 million people with DM 2 now (2018) according to the International Diabetic Federation. Adjusted forecasts of specialists are even more debilitating as their prognosis is 550 million patients with DM 2 up to 2030. The purpose of the study was to summarize data on the role of metabolic disturbances, oxidative stress and endothelial dysfunction in the formation of micro- and macrovascular complications of DM 2. Results and discussion. We examined the main pathogenetic mechanisms and risk factors for the development of cardiovascular complications of DM 2, its relationships and comorbidity with ischaemic heart disease, arterial hypertension and chronic cardiac insufficiency. Significant importance of hyperglycaemia, insulin resistance, lipid metabolic disturbances, haemostasis, proteinuria and albuminuria is emphasized, the above factors facilitating the development of DM 2 complications and their clinical manifestation and considerably worsening the course of the disease. As a rule, a patient with DM 2 has several cardiovascular risk factors, so each of them should be adjusted according to existing recommendations. Patients with DM 2 require special monitoring of cardiologists and endocrinologists, a more careful approach to the choice of therapy and prevention of cardiovascular complications. Accordingly, treatment of patients in this category should include both the correction of metabolic disorders and the influence on risk factors for the development of cardiovascular pathology. Having analyzed the data on metabolic disturbances, oxidative stress and endothelial dysfunction in the formation of micro- and macrovascular complications of DM 2 we distinguished several preventive and therapeutic actions. These actions are aimed at correction of these factors in order to prevent the development and progression of cardiovascular complications of DM 2. According to the results of the NAVIGATOR study, patients with impaired glucose tolerance and other cardiovascular risk factors that had a series of glycemic tests, diuretics and statins, were associated with an increased risk of developing the first identified DM 2 while the effect of beta-blockers was negligible. The use of a fixed combination of perindopril, indapamide and calcium channel blockers in patients with hypertension and DM 2 (ADVANCE study) contributed to a reduction in the relative risk of adverse cardiovascular events, and also provided an additional reduction in mortality in patients with DM 2. Conclusion. Thus, the correction of the above mentioned risk factors, as well as modification of the lifestyle, will help to prevent the onset or delay of the progression of complications of DM 2 by the cardiovascular system, which in turn will improve the quality of life and prognosis in these patients.