Información del artículo
La arteriosclerosis es la causa más frecuente de morbilidad y mortalidad cardiovascular en pacientes con diabetes mellitus tipo 2. En los últimos años, estudios epidemiológicos y de intervención han identificado el estado posprandial, caracterizado por un aumento rápido y prolongado de los valores de glucosa en sangre, como un factor de riesgo directo e independiente de arteriosclerosis que contribuye al desarrollo de la enfermedad cardiovascular. La hiperglucemia posprandial podría tener un efecto tóxico directo sobre el endotelio vascular mediado por el estrés oxidativo, lo que favorecería el desarrollo de la disfunción endotelial, una condición protrombótica y proinflamatoria, a través de la producción de radicales libres. Este efecto es independiente de otros factores de riesgo cardiovascular, como la hiperlipidemia. El control y la corrección de los valores de glucemia posprandial es una estrategia muy importante en la prevención de la enfermedad cardiovascular asociada a la diabetes. En esta revisión se han examinado los estudios epidemiológicos y de intervención que asocian la hiperglucemia posprandial con el riesgo de enfermedad cardiovascular, los mecanismos involucrados en estos efectos y las diferentes estrategias terapéuticas para controlar la hiperglucemia posprandial, que incluyen cambios en el estilo de vida y fármacos como los secretagogos de corta duración, los inhibidores de las alfaglucosidasas intestinales, los análogos de insulina de acción rápida y nuevos agentes en desarrollo, como el análogo de amilina, pramlintida; la hormona insulinotrópica GLP-1 y sus homólogos como la exendina, los inhibidores de la dipeptidilpeptidasa IV (DPPIV) o la insulina inhalada.
Palabras clave:
Glucosa posprandial
Riesgo cardiovascular
Diabetes mellitus tipo 2
Atherosclerosis is the most frequent cause of the increased cardiovascular morbidity and mortality observed in type 2 diabetic patients. Over the past few years, epidemiological and preliminary intervention studies have identified that the posprandial state, characterized by a rapid and large increase in blood glucose levels, is a direct and independent risk factor for atherosclerosis and a contributing factor to the development of cardiovascular disease. Posprandial hyperglycemia may have a direct toxic effect on the vascular endothelium, mediated by oxidative stress, which favors the development of endothelial dysfunction, a prothrombotic and proinflammatory condition, through the production of free radicals. This effect is independent of other cardiovascular risk factors such as hyperlipidemia. The control and correction of posprandial glucose levels is an important strategy in the prevention of diabetes-related cardiovascular disease. In this review, epidemiological and intervention studies that associate posprandial hyperglycemia with cardiovascular risk, the mechanisms involved in this effect, and the distinct therapeutic strategies to control posprandial hyperglycemia are reviewed. These therapeutic strategies include lifestyle changes, drugs such as short-acting secretagogues, alpha-glucosidase inhibitors, fast-acting insulin analogues, and new agents under development, such as the synthetic human amylin analogue pramlintide, the insulinotropic hormone GLP-1, a homologue of GLP-1-exendin, dipeptidylpeptidase IV inhibitors (DPPIV) and inhaled insulin formulations.
Key words:
Posprandial glucose
Cardiovascular risk
Type 2 diabetes mellitus
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