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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDiabetes mellitus and cardiovascular disease (CVD) are often found concomitantly. According to data from the University Hospital of the West Indies, \u223c60% of diabetic patients who are admitted have evidence of CVD. This combination is particularly pervasive among female patients [Ferguson TS et al. \u003Cem\u003EDiab Vasc Dis Res\u003C\/em\u003E 2010]. This article discusses the mechanisms of disease and new evidence that may help clinicians manage these diseases more efficiently.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDiabetes mellitus (DM) and cardiovascular disease (CVD) are often found concomitantly. According to data from the University Hospital of the West Indies, \u223c60% of diabetic patients who are admitted have evidence of CVD. This combination is particularly pervasive among female patients [Ferguson TS et al. \u003Cem\u003EDiab Vasc Dis Res\u003C\/em\u003E 2010]. Michael Boyne, MD, FRCPC, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, discussed the mechanisms of disease and new evidence that may help clinicians manage these diseases more efficiently.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIslet alpha (\u03b1)- and beta (\u03b2)-cell hormones play a key role in glucose homeostasis. In healthy subjects, \u03b1-cells secrete glucagon and \u03b2-cells secrete insulin. However, in diabetic subjects, there is excessive secretion of glucagon from the \u03b1-cells and insufficient secretion of insulin as a result of \u03b2-cell dysfunction, apoptosis, and \u03b2-cell loss. Therefore, early insulin therapy may preserve \u03b2-cell function and promote better metabolic control [Alvarsson M et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2003; Ryan EA et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2004].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EGlucagon-like peptide-1 (GLP-1) is also an important incretin hormone that affects glucoregulation. GLP-1 is secreted upon ingestion of food and stimulates insulin secretion only in the presence of elevated plasma glucose levels. In patients with T2DM, GLP-1 infusion improved insulin and glucagon levels as glucose approached normal values (ie, insulin levels decreased and glucagon levels rebounded as a result of GLP-1 infusion when normal glucose values were attained) [Nauck MA et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 1993].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIncretin mimetics (GLP-1 receptor agonists) and incretin enhancers (inhibitors of dipeptidyl peptidase-4, or DPP-4), which increase active GLP-1 function, may provide a treatment solution. The DPP-4 inhibitor sitagliptin has been shown to reduce hemoglobin A1C (HbA1C) levels by 0.5% to 1.0% with few adverse events and no weight gain [Drucker DJ \u0026amp; Nauck MA. \u003Cem\u003ELancet\u003C\/em\u003E 2006; Aschner P et al. \u003Cem\u003EDiabetes Obes Metab\u003C\/em\u003E 2010]. In a 54-week study by Williams-Herman and colleagues, initial sitagliptin + metformin combination therapy reduced HbA1C levels significantly and improved markers of \u03b2-cell function in patients with T2DM [Williams-Herman D et al. \u003Cem\u003ECurr Med Res Opin\u003C\/em\u003E 2009]. These benefits were observed with a low incidence of adverse events, including hypoglycemia.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAdditionally, a safety analysis of sitagliptin, performed by Williams-Herman et al, revealed that sitagliptin 100 mg daily was generally well tolerated in clinical trials, lasting up to 2 years. From a CVD standpoint, sitagliptin therapy was not associated with an increase in major adverse cardiovascular event risk [Williams-Herman D et al. \u003Cem\u003EBMC Endocr Disord\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThere is conflicting data concerning the role of DM as a coronary risk equivalent. While some studies have concluded that DM confers equal mortality risk as prior myocardial infarction, other analyses have not found as strong of a relationship [Haffner SM et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1998; Bulugahapitiya U et al. \u003Cem\u003EDiabet Med\u003C\/em\u003E 2009; Booth GL et al. \u003Cem\u003ELancet\u003C\/em\u003E 2006]. Current guidelines have incorporated the concept of DM as a CVD risk equivalent into their clinical recommendations, but this relationship has yet to be definitively established.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe management of DM and CVD presents a complex clinical challenge. New evidence has brought to light the mechanisms of disease and possible treatment strategies. Further investigation is warranted to assess the long-term safety and efficacy of these novel approaches.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/7\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmq7e\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}