1,721,111 research outputs found
Decadimento cognitivo e diabete mellito: possibile ruolo neuroprotettivo degli analoghi del GLP-1
No full textNon previst
La scelta terapeutica nel paziente diabetico anziano: una sfida controversa in presenza di fragilità.
No full textNon present
Hypothyroidism and endothelial function: a marker of early atherosclerosis?
No full textEndothelial dysfunction represents an important pathway thereby cardiovascular risk factors promote the development and progression of atherosclerosis. Hypothyroidism is associated with an increased cardiovascular risk, and the assessment of endothelium function is recognised an effective tool for the detection of evidence of preclinical cardiovascular alterations. Both vascular smooth muscle cells and endothelium play pivotal roles in modulating vascular tone and both are potential targets of thyroid hormone action. The pathogenesis of the association between endothelial dysfunction and hypothyroidism is complex and still not well established. The presence of traditional and emerging risk factors may contribute to the development of endothelium impairment, generating a chronic state of injury that triggers abnormal endothelial response. Levothyroxine replacement therapy is currently used for restoring euthyroidism and improving cardiovascular risk of hypothyroid patients. The decision to treat patients with subclinical hypothyroidism should depend on the presence of risk factors, rather than on a TSH threshold. However, the actual effectiveness of thyroid hormone substitution in reducing the risk of cardiovascular events, especially in subclinically hypothyroid patients, remains to be elucidated. Large multicenter, placebo-controlled prospective trials are necessary to address the issue. The article also discusses recent patents in this field
Ipotiroidismo subclinico, fattori di rischio cardiovascolare e funzionalità endoteliale
No full text
Thyroid function and carotid artery intima-media thickness
No full textWe read with interest the article by Takashima et al1 on
the characterization of subclinical thyroid dysfunction from
the cardiovascular and metabolic viewpoints. Beside several
metabolic parameters, the authors investigated a possible
association between thyroid function and carotid artery
intima – media thickness (IMT), in a population-based,
cross-sectional survey. To date, carotid IMT measurement
by high-resolution ultrasound is considered a close marker
of early atherosclerotic changes and a widely accepted
surrogate endpoint for cardiovascular events.2,
Metformin: an inexpensive and effective treatment in people with diabetes and COVID-19?
Full text linkMetformin: an inexpensive and effective treatment in people with diabetes and COVID-19?
Comment
Does Treating Subclinical Hypothyroidism Improve Markers of Cardiovascular Risk? Review
No full textSubclinical hypothyroidism is defined as an elevated serum thyroid-stimulating hormone (TSH) level in the face of normal free thyroid hormone values. The overall prevalence of subclinical hypothyroidism is 4-10% in the general population and up to 20% in women aged >60 years. The potential benefits and risks of therapy for subclinical hypothyroidism have been debated for 2 decades, and a consensus is still lacking. Besides avoiding the progression to overt hypothyroidism, the decision to treat patients with subclinical hypothyroidism relies mainly on the risk of metabolic and cardiovascular alterations. Subclinical hypothyroidism causes changes in cardiovascular function similar to, but less marked than, those occurring in patients with overt hypothyroidism. Diastolic dysfunction both at rest and upon effort is the most consistent cardiac abnormality in patients with subclinical hypothyroidism, and also in those with slightly elevated TSH levels (>6 mIU/L). Moreover, mild thyroid failure may increase diastolic blood pressure as a result of increased systemic vascular resistance. Restoration of euthyroidism by levothyroxine replacement is generally able to improve all these abnormalities. Early clinical and autopsy studies had suggested an association between subclinical hypothyroidism and coronary heart disease, which has been subsequently confirmed by some, but not all, large cross-sectional and prospective studies. Altered coagulation parameters, elevated lipoprotein (a) levels, and low-grade chronic inflammation are regarded to coalesce with the hypercholesterolemia of untreated patients with subclinical hypothyroidism to enhance the ischemic cardiovascular risk. Although a consensus is still lacking, the strongest evidence for a beneficial effect of levothyroxine replacement on markers of cardiovascular risk is the substantial demonstration that restoration of euthyroidism can lower both total and low-density lipoprotein-cholesterol levels in most patients with subclinical hypothyroidism. However, the actual effectiveness of thyroid hormone substitution in reducing the risk of cardiovascular events remains to be elucidated. In conclusion, the multiplicity and the possible reversibility of subclinical hypothyroidism-associated cardiovascular abnormalities suggest that the decision to treat a patient should depend on the presence of risk factors, rather than on a TSH threshold. On the other hand, levothyroxine replacement therapy can always be discontinued if there is no apparent benefit. Levothyroxine replacement therapy is usually safe providing that excessive administration is avoided by monitoring serum TSH levels. However, the possibility that restoring euthyroidism may be harmful in the oldest of the elderly population of hypothyroid patients has been recently raised, and should be taken into account in making the decision to treat patients with subclinical hypothyroidism who are aged >85 years
I nuovi farmaci per il diabete: gli inibitori del co-trasportatore sodio-glucosio di tipo 2 (SGLT-2i)
No full textGli antagonisti del recettore del co-trasportatore sodio-glucosio di tipo 2 (SGLT-2i), i farmaci più recenti per il diabete di tipo 2, esercitano la loro azione a livello renale. Il rene svolge un ruolo chiave nell’omeostasi glicemica
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