الملخص
It is well established that diabetes is one of the major risk
factors for atherosclerosis. and diabetic patients have a two- to
four- fold higher risk of coronary heart disease than non-diabetic
individuals. The atherosclerotic complications constitute the main
cause of mortality among diabetes patients, in general, and in type-
2 diabetics, in particular. Although the atherosclerotic process is
indistinguishable from that affecting the non-diabetic population,
it begins earlier and may be more severe. However, the accelerated
atherosclerosis in diabetes involves a multitude of mechanisms
including oxidative modification of low density lipoproteins through
the oxidative stress accompanying the pathology of diabetes.
Homocysteine causes autoxidation of LDL through generation of
the superoxide radical and reduction of the antioxidant status.
The reaction between glucose and protein or lipoproteins leading
to glycated products in arterial walls is also involved. Angiotensin II
is known to be a potent stimulator of ROS production in endothelial
cells and vascular smooth muscle cells, and ACE inhibitors have
been shown to increase endogenous oxidant scavengers. and to
enhance glutathione-dependent antioxidant defense.
Thirty normotensive subjects of the same socioeconomic class
were recruited into the study and were divided into three groups.
Group l (controls) included l0 healthy non-obese individuals,
Group lI and group III subjects (l0 patients in each group) were
type 2 diabetics with atherosclerotic coronary artery disease
(CAD). The treatment of subjects in Group ll was supplemented
by an antioxidant combination, while subjects in Group III low
daily dose of 12.5 mg of the ACEI captopril constituted the adjunct
therapy. The aim of the present study was to compare the possible role
of supplementation with either a low dose of the ACE inhibitor
captopril or a combination of antioxidants to the regular treatment
regimens of type 2 diabetic patients with CAD on some markers to
atherosclerosis.
The results of a three month follow-up of type 2 diabetic
patients indicated that adjunct treatment with antioxidants or low-
dose captopril improved all parameters tested, including glycemic
control, oxidative stress, and hyperhomocysteinemia. A very
encouraging observation was the favorable response of ox-LDL
Ab to antioxidant or captopril treatment. The clinical improvement
and the observed gradual shift in the disease indices toward normal
levels make the use of the suggested adjuvant therapy in type 2
diabetics with cardiovascular disease worth pursuing in a larger
clinical study.
the disease indices toward normal levels make the use of the suggested
adjuvant therapy in type 2 diabetics with cardiovascular disease worth
pursuing in a larger clinical study.