摘要
In cardiovascular(CV) diabetology a "one-size fitsall" approach needs caution as vasculopathy and CV manifestations in patients with type 2 diabetes(T2D) with short disease duration are different as compared to those with longer duration. This is of relevance when interpreting results of CV outcome trials as responses to any intervention aimed to reduce CV risk might be different in patients with established vasculopathy as compared to those without, where also the duration of the intervention may play a role. Additionally, the mode-of-action of the intervention and its assumed time to peak CV risk modulation need to be taken into account: an intervention with possibly immediate effects, like on blood pressure or other direct functional dynamic parameters such as endothelial function or renal hemodynamics, could likely provide a meaningful impact on CV outcomes over a shorter time span than interventions that primarily target pathways that work on atherosclerotic processes, organ-remodelling, or vessel integrity. We are now faced with CV outcome results to interpret from a plethora of outcomes trials in T2 D, some of which are testing the CV risk modulation predominantly beyond glucose lowering, e.g., as is the case for several trials testing the newer therapy classes di-peptidyl peptidase-4 inhibitors, glucagonlike protein-1 receptor analogues and sodium glucose co-transporter-2 inhibitors, and this paper reviews the data that support a call for a multiaxial approach to interpret these results.
In cardiovascular （CV） diabetology a ＂one-size fitsall＂approach needs caution as vasculopathy and CVmanifestations in patients with type 2 diabetes （T2D）with short disease duration are different as comparedto those with longer duration. This is of relevance wheninterpreting results of CV outcome trials as responsesto any intervention aimed to reduce CV risk might bedifferent in patients with established vasculopathy ascompared to those without, where also the durationof the intervention may play a role. Additionally, themode-of-action of the intervention and its assumedtime to peak CV risk modulation need to be takeninto account an intervention with possibly immediateeffects, like on blood pressure or other direct functionaldynamic parameters such as endothelial function orrenal hemodynamics, could likely provide a meaningfulimpact on CV outcomes over a shorter time span thaninterventions that primarily target pathways that workon atherosclerotic processes, organ-remodelling, orvessel integrity. We are now faced with CV outcomeresults to interpret from a plethora of outcomes trials inT2D, some of which are testing the CV risk modulationpredominantly beyond glucose lowering, e.g. , as isthe case for several trials testing the newer therapyclasses di-peptidyl peptidase-4 inhibitors, glucagonlikeprotein-1 receptor analogues and sodium glucoseco-transporter-2 inhibitors, and this paper reviews thedata that support a call for a multiaxial approach tointerpret these results.
