Effets du contrôle de l'hyperglycémie sur la morbi-mortalité cardiovasculaire (type 1 & type 2)

Epidemiological studies among diabetic populations have clearly shown a positive association between hyperglycemia and the risk for cardiovascular events independently of other riskfactors. Moreover, manypathophysiological data indicate the deleterious role of hyperglycemia on the arterial wall through promotion of inflammation and oxidation, and through the local accumulation of Advanced Glycosylation End products (AGE). However, the demonstration of the cardiovascular benefit secondary to the reduction of hyperglycemia is not clear. Indeed, in the UKPDS, VADT and ADVANCE trials no significant reduction of the risk for major cardiovascular events has been observed among the patients enrolled in the “intensive treatment of diabetes” group. However, the prolonged follow-up of the patients from UKPDS, VADT and ACCORD, in type 2 diabetes, and from DCCT/EDIC, in type 1 diabetes, has clearly shown a significant reduction of major cardiovascular events in the patients initially enrolled in the “intensive treatment” groups. Thus, the present data seems to indicate a real cardiovascular benefit secondary to the reduction of hyperglycemia that is “late”. This rather “late” effect could partly be due to the prolonged modification of the arterial wall promoted by the local accumulation of AGE.