Review Article
Residual Microvascular Risk in Type 2 Diabetes in 2014: Is it Time for a Re-Think? A Perspective from the Residual Risk Reduction Initiative (R3i)
Michel P Hermans1*, Jean-Charles Fruchart2, Jean Davignon3, Khalid Al-Rubeaan4, Pierre Amarenco5, Gerd Assmann6, Philip Barter7, John Betteridge8, Eric Bruckert9, M John Chapman10, Ada Cuevas11, Michel Farnier12, Ele Ferrannini13, Paola Fioretto14, Jacques Genest15, Henry N Ginsberg16, Antonio M Gotto Jr17, Dayi Hu18, Takashi Kadowaki19, Tatsuhiko Kodama20, Michel Krempf21, Yuji Matsuzawa22, Jesús Millán Núñez-Cortés23, Carlos Calvo Monfil24, Hisao Ogawa25, Jorge Plutzky26, Daniel J Rader27, Željko Reiner28, Shaukat Sadikot29, Raul D Santos30, Evgeny Shlyakhto31, Piyamitr Sritara32, Rody Sy33, Alan Tall34, Chee-Eng Tan35, Lale Tokgözoglu36, Peter P Toth37, Paul Valensi38, Christoph Wanner39, Alberto Zambon14, JunRen Zhu40and Paul Zimmet41
1Clinical university St-luc, Brussels, Belgium
2R3i Foundation, St. Alban-Anlage 46, Basel, Switzerland
3Clinical Research Institute of Montreal Montreal University Health Center and Department of Experimental Medicine, McGill University, Montreal, Canada
4University Diabetes Center, King Saud University, Riyadh, Saudi Arabia
5Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France
6Assmann Foundation for Prevention, Germany
7Centre for Vascular Research, University of New South Wales, Sydney, Australia
8University College London, London, UK
9Endocrinology and Cardiovascular Disease Prevention, Hospital Pitié-Salpêtrière, Paris, France
10University of Pierre and Marie Curie, INSERM Dyslipidemia and Atherosclerosis Research Unit, Hospital Pitié-Salpêtrière, Paris, France
11Nutrition Center, Clínica Las Condes, Santiago, Chile
12Point Medical, Dijon, France
13University of Pisa School of Medicine, and Metabolism Unit of the National Research Council (CNR) Institute of Clinical Physiology, Pisa, Italy
14Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
15McGill University and Center for Innovative Medicine, McGill University Health Center/Royal Victoria Hospital, Montreal, Canada
16Department of Medicine and Irving Institute for Clinical and Translational Research, Columbia University, New York, USA
17Weill Cornell Medical College, Cornell University, New York, USA
18Hospital of Peking University, Beijing, China
19Diabetes and Metabolic Diseases Unit, University of Tokyo, Japan
20Department of Systems Biology and Medicine, University of Tokyo, Japan
21Human Nutritional Research Center and Department of Endocrinology, Metabolic diseases and Nutrition, University Hospital Nantes, Nantes, France
22Sumitomo Hospital and Osaka University, Osaka, Japan
23University Hospital Gregorio Marañón, Madrid, Spain
24University of Concepción, Concepción, Chile
25Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, and National Cerebral and Cardiovascular Center, Osaka, Japan
26Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
27Division of Translational Medicine and Human Genetics, Smilow Center for Translational Research, Penn Cardiovascular Institute, Philadelphia, Pennsylvania, USA
28Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia
29Jaslok Hospital and Research Center, Mumbai, India
30Director of Clinical Unit of Lipids InCor- HCFMUSP, Sao Paulo, Brazil
31Federal Almazov Heart Blood Endocrinology Centre, St Petersburg, Russia
32Mahidol University, Bangkok, Thailand
33University of the Philippines-Philippine General Hospital, Manila, The Philippines
34Specialized Center of Research (SCOR) in Molecular Medicine and Atherosclerosis, Columbia University, College of Physicians & Surgeons, New York, USA
35Gleneagles Medical Centre, Singapore
36Hacettepe University, Ankara, Turkey
37CGH Medical Center, Sterling, Illinois, and University of Illinois School of Medicine, Peoria, Illinois
38Hospital Jean Verdier, Department of Endocrinology Diabetology Nutrition, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France
39University Hospital Würzburg, Würzburg, Germany
40Zhongshan Hospital, Fudan University, Shanghai, China
41Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- *Corresponding Author:
- Michel P Hermans, MD PhD
Dip Nat Sci Dip Earth Sci Dip Geog Env PG Cert (SocSc)
Endocrinology & Nutrition, UCL 54. 74 Tour
Claude Bernard +1, avenue Hippocrate 54
B 1200 Brussels, Belgium
Tel: +32 27645475
Fax: +32 27645418
E-mail: [email protected]
Received date: July 22, 2014; Accepted date: August 11, 2014; Published date: August 19, 2014
Citation: Hermans MP, Fruchart JC, Davignon J, Al-Rubeaan K, Amarenco P, et al. (2014) Residual Microvascular Risk in Type 2 Diabetes in 2014: Is it Time for a Re-Think? A Perspective from the Residual Risk Reduction Initiative (R3i). J Diabetes Metab 5:413. doi: 10.4172/2155-6156.1000413
Copyright: © 2014 Hermans MP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Microvascular complications associated with type 2 diabetes, including diabetic retinopathy, nephropathy and neuropathy, account for much of the societal burden of diabetes. Even with effective multifactorial intervention, targeting glycemia, blood pressure and lowdensity lipoprotein cholesterol, in addition to lifestyle intervention, a high residual microvascular risk persists. The Residual Risk Reduction Initiative (R3i) highlights two key priorities for reducing this residual risk. First, there should be optimal management of cardiometabolic risk factors, including atherogenic dyslipidemia, elevated triglycerides and low plasma high-density lipoprotein cholesterol, to improve lipid goal attainment. Second, consistent evidence from two major trials may merit consideration of adjunctive fenofibrate therapy to slow progression of diabetic retinopathy in type 2 diabetes patients with pre-existing disease. These data provide a strong rationale for testing in a prospective study. The R3i strongly believes that addressing both priorities is critical to reducing the substantial residual risk of microvascular complications in type 2 diabetes.
