Cardiometabolism and clinical trials


Senior physician

Pier Marco Piatti


Cardiovascular disease is substantially increased in insulin-resistant individuals with sub-diabetic hyperglycaemia, notably impaired glucose tolerance (IGT), which carries a cardiovascular risk that is little short of recently diagnosed type 2 diabetes. Increased cardiovascular risk can often be traced back 10–15 years before the diagnosis of diabetes, usually with evidence of insulin resistance and sub-diabetic hyperglycaemia. Moreover, amongst individuals presenting with a myocardial infarction, about one third are found to have undiagnosed type 2 diabetes and another third have IGT. Cardiovascular complications are now the leading cause of diabetes-related morbidity and mortality, particularly among women and the elderly. In adults with diabetes, the risk of cardiovascular disease (CVD) is two to four-fold greater than in non-diabetics. Comorbid conditions (hypertension, dyslipidemia and smoking) combine with hyperglycemia to contribute to accelerated atherosclerosis. One third of people with type 2 diabetes are undiagnosed. In addition a significant proportion of patients are diagnosed with diabetes only when they present with cardiopathy.

Research activity

The research of Cardiometabolism and clinical trials Unit is in line with the new guide-lines of the European Society of Diabetology and the European Society of Cardiology suggesting the importance to detect glucose intolerance or type 2 diabetes through an oral glucose tolerance test in all subjects with an ischemic cardiopathy in the presence of fasting glucose less than 126 mg/dl. Preliminary data suggest that about 60% of patients with ischemic heart disease will have alterations of glucose metabolism even with fasting blood glucose less than 100 mg/dl.
The CARDIO-DIABETES project will help to recognize new pathogenetic mechanisms and innovative therapies with the final goal to prevent type 2 diabetes and cardiovascular disease with a reduction of costs for the national health ministry.