Cardiovascular risk and its determinants in high risk patients

Egberdina Gesina Gerrits

Cardiovascular risk and its determinants in high risk patients

Egberdina Gesina Gerrits

Faculteit Medische Wetenschappen/UMCG

Onderzoeksoutput

604 Downloads (Pure)

Samenvatting

Mensen met type 2 diabetes die door hun huisarts met geneesmiddelen goed zijn gereguleerd, hebben een levensverwachting die even hoog is als die van de algemene Nederlandse bevolking. Deze conclusie trekt onderzoeker Esther Gerrits uit een langlopende studie in Zwolle.

Het merendeel van de mensen met type 2 diabetes is onder behandeling en controle van de huisarts. Mensen met type 2 diabetes hebben een verhoogde kans op hart- en vaatziekten. Daarom is de regulering van risicofactoren hiervoor, zoals verhoogde bloeddruk en cholesterol, onderdeel van de diabeteszorg. Patiënten die deze zorg krijgen, hebben eenzelfde levensverwachting als de algemene bevolking, zo stelde Gerrits vast. Daarnaast vond zij dat diabeten met een voorgeschiedenis van hart- en vaatziekten, bijvoorbeeld een doorgemaakt hartinfarct, of eiwit in de urine, wel een verminderde levensverwachting hebben ten opzicht van de algemene bevolking. Eiwit in de urine duidt op schade in de bloedvaten en nieren en kan een voorbode zijn van (chronische) nierziekte. Het is een risicofactor voor sterfte bij diabeten.

Transmurale zorg

In de regio Zwolle is de diabeteszorg transmuraal georganiseerd. Dit houdt in dat de type 2 diabetes patiënten deelnemen aan het ZODIAC project, dat staat voor ‘Zwolle Outpatient Diabetes project Integrating Available Care.’ In het kader van dit project worden alle diabeten een keer per jaar door een diabetesverpleegkundige gescreend op complicaties. Een internist in het ziekenhuis beoordeelt de resultaten hiervan en adviseert de huisarts over eventuele aanpassingen in de behandeling.

Originele taal-2	English
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	Bilo, Henk, Supervisor Gans, Rijk, Supervisor Smit, Andries, Supervisor Lutgers, Helen, Supervisor
Datum van toekenning	8-jan.-2013
Uitgever	[s.n.]
Gedrukte ISBN's	9789461083791
Elektronische ISBN's	9789461083807
Status	Published - 2012

Toegang tot document

Complete thesisFinal author's version, 6,14 MB

Handle.net

Permanente koppeling

Citeer dit

@phdthesis{84b09cc859244125bb12737f300b171c,

title = "Cardiovascular risk and its determinants in high risk patients",

abstract = "Increased glycemic and oxidative stress play a pivotal role in the pathogenesis of vascular damage in high risk groups such as patients with diabetes mellitus (DM) or chronic kidney disease, culminating in cardiovascular events, endstage renal disease (ESRD) and mortality. Chronic exposure to glycemic and oxidative stress translates in often long lasting and cumulative changes. Such effects are also described as metabolic memory and can be subdivided in short-term and long-term metabolic memory. Short-term metabolic, specifically glycemic memory is reflected by e.g. the degree of glycation of hemoglobin, measured as HbA1c subfraction representing the degree of glycemic control over approximately the last 6 – 8 weeks. Long-term metabolic memory can be reflected by the accumulation of advanced glycation endproducts (AGEs) in tissue components with slow turnover, such as collagen in the dermis of the skin which has a lifetime of about 15 years. The relationship between poor metabolic control and the development or progression of diabetic complications has been established in type 1 DM in the Diabetes Control and Complications Trial (DCCT) and in type 2 DM in the United Kingdom Prospective Diabetes Study (UKPDS) during the nineties (1,2). The importance of long-term metabolic memory is highlighted in the long-term followup of both landmark trials which also showed an increasing benefit of good glycemic control over prolonged time (>10 years), even when the good glycemic control was limited to the initial intervention period at the early stage of diabetes (3,4). Patients with chronic renal insufficiency have decreased renal clearance capacity of serum AGEs and AGE-free adducts, contributing to the accumulation of AGEs. Higher levels of AGEs may enhance oxidative stress, introducing a vicious circle. A treatment option for end stage renal disease such as hemodialysis, may in itself also induce repetitive bouts of oxidative stress and may reduce levels of protective antioxidants. All these imbalances of oxidative stress status and increased levels of AGEs willcontribute to vascular morbidity and mortality in the long term. Increased levels of AGEs may represent a useful marker of enhanced glycemic and oxidative stress, and moreover long-term metabolic memory. We assessed skin autofluorescence (AF), a noninvasive measurement reflecting tissue AGE accumulation.",

keywords = "Cardiologie",

author = "Gerrits, {Egberdina Gesina}",

year = "2012",

language = "English",

isbn = "9789461083791",

publisher = "[s.n.]",

school = "University of Groningen",

}

TY - BOOK

T1 - Cardiovascular risk and its determinants in high risk patients

AU - Gerrits, Egberdina Gesina

PY - 2012

Y1 - 2012

N2 - Increased glycemic and oxidative stress play a pivotal role in the pathogenesis of vascular damage in high risk groups such as patients with diabetes mellitus (DM) or chronic kidney disease, culminating in cardiovascular events, endstage renal disease (ESRD) and mortality. Chronic exposure to glycemic and oxidative stress translates in often long lasting and cumulative changes. Such effects are also described as metabolic memory and can be subdivided in short-term and long-term metabolic memory. Short-term metabolic, specifically glycemic memory is reflected by e.g. the degree of glycation of hemoglobin, measured as HbA1c subfraction representing the degree of glycemic control over approximately the last 6 – 8 weeks. Long-term metabolic memory can be reflected by the accumulation of advanced glycation endproducts (AGEs) in tissue components with slow turnover, such as collagen in the dermis of the skin which has a lifetime of about 15 years. The relationship between poor metabolic control and the development or progression of diabetic complications has been established in type 1 DM in the Diabetes Control and Complications Trial (DCCT) and in type 2 DM in the United Kingdom Prospective Diabetes Study (UKPDS) during the nineties (1,2). The importance of long-term metabolic memory is highlighted in the long-term followup of both landmark trials which also showed an increasing benefit of good glycemic control over prolonged time (>10 years), even when the good glycemic control was limited to the initial intervention period at the early stage of diabetes (3,4). Patients with chronic renal insufficiency have decreased renal clearance capacity of serum AGEs and AGE-free adducts, contributing to the accumulation of AGEs. Higher levels of AGEs may enhance oxidative stress, introducing a vicious circle. A treatment option for end stage renal disease such as hemodialysis, may in itself also induce repetitive bouts of oxidative stress and may reduce levels of protective antioxidants. All these imbalances of oxidative stress status and increased levels of AGEs willcontribute to vascular morbidity and mortality in the long term. Increased levels of AGEs may represent a useful marker of enhanced glycemic and oxidative stress, and moreover long-term metabolic memory. We assessed skin autofluorescence (AF), a noninvasive measurement reflecting tissue AGE accumulation.

AB - Increased glycemic and oxidative stress play a pivotal role in the pathogenesis of vascular damage in high risk groups such as patients with diabetes mellitus (DM) or chronic kidney disease, culminating in cardiovascular events, endstage renal disease (ESRD) and mortality. Chronic exposure to glycemic and oxidative stress translates in often long lasting and cumulative changes. Such effects are also described as metabolic memory and can be subdivided in short-term and long-term metabolic memory. Short-term metabolic, specifically glycemic memory is reflected by e.g. the degree of glycation of hemoglobin, measured as HbA1c subfraction representing the degree of glycemic control over approximately the last 6 – 8 weeks. Long-term metabolic memory can be reflected by the accumulation of advanced glycation endproducts (AGEs) in tissue components with slow turnover, such as collagen in the dermis of the skin which has a lifetime of about 15 years. The relationship between poor metabolic control and the development or progression of diabetic complications has been established in type 1 DM in the Diabetes Control and Complications Trial (DCCT) and in type 2 DM in the United Kingdom Prospective Diabetes Study (UKPDS) during the nineties (1,2). The importance of long-term metabolic memory is highlighted in the long-term followup of both landmark trials which also showed an increasing benefit of good glycemic control over prolonged time (>10 years), even when the good glycemic control was limited to the initial intervention period at the early stage of diabetes (3,4). Patients with chronic renal insufficiency have decreased renal clearance capacity of serum AGEs and AGE-free adducts, contributing to the accumulation of AGEs. Higher levels of AGEs may enhance oxidative stress, introducing a vicious circle. A treatment option for end stage renal disease such as hemodialysis, may in itself also induce repetitive bouts of oxidative stress and may reduce levels of protective antioxidants. All these imbalances of oxidative stress status and increased levels of AGEs willcontribute to vascular morbidity and mortality in the long term. Increased levels of AGEs may represent a useful marker of enhanced glycemic and oxidative stress, and moreover long-term metabolic memory. We assessed skin autofluorescence (AF), a noninvasive measurement reflecting tissue AGE accumulation.

KW - Cardiologie

M3 - Thesis fully internal (DIV)

SN - 9789461083791

PB - [s.n.]

ER -

Cardiovascular risk and its determinants in high risk patients

Samenvatting

Toegang tot document

Handle.net

Vingerafdruk

Citeer dit