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Diabetes, a Dishonest Disease with No Obvious Symptoms: Women More Exposed to Cardiovascular Risks and Strokes



The type 2 diabetes in Italy it affects nearly 5 million people (2016 ISTAT data: about 4 million people with known diabetes and over 1 million who have no perception of the disease). What gives the biggest alarm on the eve of World Diabetes Day on November 14 is that nearly 1 million people suffer from diabetes but he is not aware of it: it is indeed a matter of a dishonest disease with no obvious symptoms; Therefore, it is essential to diagnose it early, also because the therapies available today allow effective intervention in the early stages of the disease, which can cause a risk of cardiovascular disease almost double compared to those unaffected.

GENDER DIFFERENCES Recent studies have denied a widespread prejudice that cardiovascular risk is higher in men than in women. A few years ago, in particular, scientific evidence shows that there is an important difference in the evolution of diabetes-related cardiovascular risks.

"Women with diabetes are 44% more likely to develop coronary artery disease than men – emphasizes Cesare Berra, Head of the Endocrinologist-Metabolic Department of the MultiMedica Group in Milan. – There is also a higher risk in women. incident: one 2.28 in females and 1.83 in males. In particular, this adverse event often arises in a very well-defined population, such as 35-54 year old women."

The first studies to support this thesis were published as early as 2014, when a major meta-analysis on behalf of Pitersen compared nearly 900,000 individuals aged 20 to 100 years with type 2 diabetes who suffered cardiovascular disease. This was followed by other equally important studies published in leading scientific journals. Similar results also emerged from another meta-analysis, also from Pitersen, also published in lancet, who studied almost 800,000 subjects.

Even some Italian studies (Riace, Mannucci) are very significant: the common element that highlights is the need for greater attention to the development of diabetes-associated complications in women. About the causes are not yet certain: this is probably due to the so-called cofactors, such as dyslipidemia or hypertension, which, in women, have a more incisive role. Then there is a cultural element, that is, less attention to monitoring the effects of diabetes on women than on men. The prevailing hypothesis until recently, in fact, was that premenopausal women were almost protected by hormones: based on this belief, the presence of women in large clinical trials was limited. This line regarding the female gender should acquire greater importance.

PREVENTION, AVOID SMOKING ON COUNTER Atherosclerotic Diseases – Prevention remains a cornerstone in the fight against diabetes and goes through some key points: certainly a correct lifestyle, marked by a balanced diet and regular physical activity, but above all by a lack of smoke, in particular the cigarette "Smoking should be demonized as much as possible. – highlights Cesare Berra. – If it is already in the total population, it can cause cancer because it has a carcinogenic factor. In those diabetics, smoking certainly causes the risk of developing atherosclerotic diseases of small vessels, ie points where it is not even possible to make a proper diagnosis"

NEW THERAPIES – To prevent a metabolic disease, it is therefore necessary to lead a healthy lifestyle and, for diabetes in particular, an early diagnosis. Once diagnosed, it should be treated with appropriate drug therapy. "Today there are several categories of different molecules for each category, useful in treating different forms of diabetes in a personalized way. – explains Cesare Berra. – It must, in fact, take into account which The phenotype (appearance) assumes the disease: it is necessary to identify the individuals at higher risk, also in relation to the characteristics of the insulin resistance disease, insulin secretion deficiency or other peculiar aspects that may suggest a propensity to develop nephrotic cardiovascular complications. vascular. For each type of person with diabetes, appropriate treatment should be identified: Do not attempt as before, but immediately start with the best drug for this type of patient. Only with this type of therapeutic approach is it possible to prevent the development of heart attacks and nephropathic effusions."

"Recent and extensive clinical studies show that new treatments already available in Italy, a little more expensive than traditional therapies, reduce cases of hospitalization, cardiovascular decompensation, deaths from cardiovascular causes in those at higher risk. In addition, these therapies have very important extraglycemic effects: they reduce weight and blood pressure, prevent worsening renal function, often linked to diabetes. In fact, they intervene in diabetes and all its side effects, with cardiovascular and nephrovascular prevention. Unfortunately, these drugs are not yet sufficiently prescribed. This limit must be exceeded, as there is a risk of dividing patients into categories. One must always be able to intervene properly, also because the data show that the sooner actions are taken with appropriate medications, the more efficient is the result of all points of view."

COMMITMENT AGAINST DIABETES COMPLICATIONS"We consider treating diabetes a global health challenge and believe it is critical to promote patient centrality, always – lights Sabrina Cremascoli, General Manager, Mundipharma Pharmaceuticals Italia. – Our reality has a strong heritage throughout Europe in general and specialized medicine. Through daily research and attention to the cardiovascular and renal complications of diabetes, it is our intention to strengthen our commitment to providing innovative medicines that improve patients' quality of life and enable the sustainability of the healthcare system. " .


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