Publication: Pioglitazonun klinik kullanımındaki kardiyovasküler riskler ve mesane kanseri açısından değerlendirilmesi
Abstract
Tip 2 diabetes mellitus (T2DM); ciddi, kronik ve sıklığı hızla artmakta olan bir hastalıktır. T2DM hastalarının ciddi kardiyovasküler hastalıklara yakalanma oranları, diyabet hastası olmayanlara göre 2 ile 4 kat daha yüksektir. Ayrıca bu hastaların çoğunluğu insülin dirençlidir ve belirgin kardiyovasküler risk faktörlerinin olduğu metabolik anormalliklerle ilişkilidirler. Tiyazolidindionlar insülin direncini azaltarak bu riskleri hedef almaktadırlar. Pioglitazonun lipid profili ve diğer ilişkili kardiyovasküler durumlarda yararlı etkileri olduğu gösterilmiştir. Pioglitazon; T2DM’li hastalarda insülin duyarlılığını, glisemik kontrolü, dislipidemiyi, hipertansiyonu düzenler. Hepatik ve periferal dokuların ünsüline duyarlılığını arttırarak, açlık ve postprandiyal plazma seviyelerini düşürür. Aynı zamanda pioglitazon HbA1c (glikolize hemoglobin) değerini %0.5-%1.5 oranında düşürerek; diğer oral antidiyabetik ilaçlarla veya insülin ile kombine kullanıldığında glisemik kontrolün etkililik ve sürekliliğini sağlar. Pioglitazon ve glimepirid etken maddelerinin kardiyovasküler risk faktörleri bakımından etkilerini incelerken CHICAGO ve PERISCOPE çalışmalarındaki ortak riskler açısından değerlendirme yapılmıştır. Çıkan sonuçlar pioglitazon kullanımına bağlı olarak kardiyovasküler risklerin düşük olduğuna işaret etmektedir. Diğer taraftan kardiyovasküler riskler açısından yapılan değerlendirmeye göre “konjestif kalp yetmezliği için hastaneye yatış” riskinde artış gözlenmiştir. Yapılan çalışmada pioglitazonun mesane kanseri ile ilişkili olup olmadığını değerlendirmek amacıyla beş farklı çalışmanın sonuçları ele alınmıştır. Sonuç olarak pioglitazonun mesane kanseri riskinin artışı ile ilişkili olabileceği düşünülmektedir. Bunun yanısıra 24 aydan uzun süren tedaviler mesane kanseri artışı ile ilişkili olabilir. 10-yıllık izleme çalışmasının en son sonuçları temmuz 2015’te elimize geçecektir; bu sonuçlar, en az 2.5 yıl devam eden pioglitazon tedavisinin uzun dönemdeki sonuçlarını daha fazla anlamamızı sağlayabilir. abetes mellitus, tiyazolidindion, pioglitazon, kardiyovasküler risk, mesane kanseri. .
Evaluation of Cardiovascular Risks And Bladder Cancer in Clinical Use of Pioglitazone Type 2 diabetes mellitus (T2DM) is a serious, chronic, and progressive disease that is rapidly increasing in prevalence. People with T2DM are two to four times more likely to develop a serious cardiovascular (CV) outcome compared with those without diabetes. Moreover, the majority of these patients have insulin resistant and significant cardiovascular risk factors that are associated with metabolic abnormalities. The thiazolidinediones target to these risks by reducing insulin resistance. Pioglitazone is known to improve insulin sensitivity, glycemic control, dyslipidemia, hypertension in patients with T2DM. Besides it decreases fasting and postprandial plasma glucose levels by improving the sensitivity of hepatic and peripheral (muscle) tissue to insulin. It also provides effective (lowering HbA1c by 0.5–1.5%) and durable glycemic control in combination with other oral antidiabetes drugs as well in combination with insulin. When examining the impact in terms of cardiovascular risk factors of Pioglitazone and glimepiride agents, CHICAGO and PERISCOPE study was carried out in terms of common risks. The results are signed to pioglitazone treated patients had a significantly lower rate on cardiovascular risks. On the other hand, increased risk of hospitalization for congestive heart failure (CHF) was observed according toour assessment. In this study, the results of five different studies are discussed to assess whether pioglitazone is associated with bladder cancer. Accordingly pioglitazone exposure was significantly associated with increased risk of bladder cancer. Besides longer than 24 monthly threrapy of pioglitazone may be associated with an increased risk of bladder cancer. But the final 10-year follow-up results will be available from July 2015 and may provide further insights into the long-term consequences of at least 2.5 years of pioglitazone therapy. Key words: Type 2 diabetes mellitus, thiazolidinedione, pioglitazone, cardiovascular risk, bladder cancer .
Evaluation of Cardiovascular Risks And Bladder Cancer in Clinical Use of Pioglitazone Type 2 diabetes mellitus (T2DM) is a serious, chronic, and progressive disease that is rapidly increasing in prevalence. People with T2DM are two to four times more likely to develop a serious cardiovascular (CV) outcome compared with those without diabetes. Moreover, the majority of these patients have insulin resistant and significant cardiovascular risk factors that are associated with metabolic abnormalities. The thiazolidinediones target to these risks by reducing insulin resistance. Pioglitazone is known to improve insulin sensitivity, glycemic control, dyslipidemia, hypertension in patients with T2DM. Besides it decreases fasting and postprandial plasma glucose levels by improving the sensitivity of hepatic and peripheral (muscle) tissue to insulin. It also provides effective (lowering HbA1c by 0.5–1.5%) and durable glycemic control in combination with other oral antidiabetes drugs as well in combination with insulin. When examining the impact in terms of cardiovascular risk factors of Pioglitazone and glimepiride agents, CHICAGO and PERISCOPE study was carried out in terms of common risks. The results are signed to pioglitazone treated patients had a significantly lower rate on cardiovascular risks. On the other hand, increased risk of hospitalization for congestive heart failure (CHF) was observed according toour assessment. In this study, the results of five different studies are discussed to assess whether pioglitazone is associated with bladder cancer. Accordingly pioglitazone exposure was significantly associated with increased risk of bladder cancer. Besides longer than 24 monthly threrapy of pioglitazone may be associated with an increased risk of bladder cancer. But the final 10-year follow-up results will be available from July 2015 and may provide further insights into the long-term consequences of at least 2.5 years of pioglitazone therapy. Key words: Type 2 diabetes mellitus, thiazolidinedione, pioglitazone, cardiovascular risk, bladder cancer .