Late effect of treatment for reducing cardiovascular risk--a hypothesis on cardiometabolic therapeutic memory.
Several clinical studies were carried out in order to decrease cardiovascular morbidity and mortality. Occasionally, long-term observational follow-up was performed after terminating the randomized, controlled clinical trials and it was found that the beneficial effect of the active treatment has been maintained in the follow-up period. This prolonged effect was originally observed in patients with type 1 or type 2 diabetes by using intensive versus conventional treatment and called metabolic memory or metabolic legacy. Nevertheless, cardiovascular risk reduction is not restricted to antihyperglycaemic treatment; therefore, it can be hypothesised that other treatment options such as lifestyle changes, antihypertensive or lipid lowering treatment may have similar effects. In fact, a late beneficial effect of lifestyle changes was observed in controlled clinical studies in subjects with impaired glucose tolerance. Moreover, sustained beneficial effect of ACE-inhibitors, statins or fibrates in subjects with high cardiovascular risk was documented in the follow-up period of randomized, controlled clinical trials. Finally, the long-term advantage of intensified versus conventional multifactorial cardiovascular intervention was proven in patients with type 2 diabetes. Taken together, this phenomenon could be called cardiometabolic therapeutic memory. The concept provides further support for initiating proper therapy for patients with moderate or high cardiovascular risks as early as possible. Following this strategy, not only immediate and short-term but, according to the concept of cardiometabolic therapeutic memory, even long-term beneficial effect of the intervention could be expected.
Jermendy
György
G
Bajcsy-Zsilinszky Hospital, 3rd Medical Department, Maglódi út 89-91, 1106 Budapest, Hungary. gyjermendy@gmail.com