Practical aspects of the control of cardiovascular risk in type 2 diabetes mellitus and the metabolic syndrome (original) (raw)
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Study on Cardiovascular Risk Factors and its Management in Type II Diabetic Patients
2017
INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of ill-health and mortality in people with type two diabetes (T2DM).Type two DM is associated with twice the risk of incident coronary heart disease (CHD) and ischemic stroke and 2–4 times increased risk of CHD and stroke mortality compared with diabetes-free individuals.1 Changes in the human environment, behavior, and lifestyle are contributing to the upsurge in the incidence of diabetes. However, better management has resulted in a longer survival of patients with diabetes, but it is accompanied by long-term chronic complications due to hyperglycemia Individuals with diabetes most often die of cardiovascular disease (CVD) rather than from a cause uniquely related to diabetes, such as ketoacidosis or hypoglycemia2 . Diabetic patients have a twofold to six fold higher incidence of cardiovascular disease than non-diabetic population. Furthermore, diabetic patients with CVD sustain a worse prognosis for survival than CVD...
The American Journal of Cardiology, 2007
Patients with type 2 diabetes mellitus die of cardiovascular disease (CVD) at rates 2-4 times higher than patients without diabetes but with similar demographic characteristics. The prevalence of diabetes is increasing in the United States and, thus, the prevention of CVD in patients with diabetes poses an urgent public health challenge. The objective of this report is to review the current knowledge base for the prevention of CVD in patients with diabetes, with particular emphasis on the control of glycemia, lipids, and blood pressure. Epidemiologic analyses suggest that each 1% increase in glycosylated hemoglobin increases the risk for CVD by approximately 18%; however, evidence from the randomized trials that have examined whether glucose lowering reduces this risk is conflicting. Randomized trials have shown that lowering low-density lipoprotein cholesterol reduces CVD event rates by 17%-43% in patients with diabetes. Limited data support a role for lowering triglycerides and increasing high-density lipoprotein cholesterol in the prevention of CVD. Evidence from clinical trials shows that reducing systolic blood pressure to <140 mm Hg results in 30%-60% reductions in CVD events; however, epidemiologic evidence suggests that lowering to optimal systolic blood pressure levels (<120 mm Hg) may be additionally beneficial.
Pharmacological Strategies to Reduce Cardiovascular Risk in Type 2 Diabetes Mellitus
Drugs, 2005
Abstract dominated by the occurrence of cardiovascular disease (CVD). Treatment of known risk factors of CVD has proven to be beneficial in terms of reduction in risk of major CVD events in the general population. Recent trials have provided information on the treatment of hyperglycaemia, hypertension, dyslipidaemia and platelet aggregation in the patient with type 2 diabetes.
Primary prevention of cardiovascular events and type 2 diabetes
Diabetes & Metabolism, 2006
The diagnosis of type 2 diabetes is based on elevated blood glucose levels. However, in most individuals, metabolic abnormalities as well as cardiovascular risk factors co-exist with a significant proportion of patients presenting with elevated blood pressure, high triglycerides and decreased HDL-cholesterol in addition to hyperglycemia. The risk of cardiovascular disease in people with type 2 diabetes is very high as cardiovascular death represents the number 1 killer in this population. An integrated approach controlling all risk factors as well as blood glucose has been demonstrated to effectively reduce the risk of cardiovascular complications. However, this requires the administration of multiple medications and some patients will have difficulties adhering to the prescribed regimen, limiting the number of drugs the physician can prescribe. In this review, we will summarize the efficacy of different approaches in primary prevention to help practitioners prioritize interventions in these situations.
Prevention of Cardiovascular Risk in Diabetic Patients – An Update
European Endocrinology, 2007
Patients with type 2 diabetes have a well-documented increased risk of cardiovascular disease (CVD) that is more than two to three times higher than the risk seen in non-diabetic subjects. 1 In spite of modern methods to treat diabetes and its complications, the increased risk is still substantial even if data on risk factor controls in national surveys have shown improving trends for blood pressure and lipid control, for example from Sweden. 2 The most important CVD risk factors to detect, treat and make follow-up visits for are elevated blood-pressure levels, dyslipidaemia and elevated low-density lipoprotein (LDL) cholesterol, as well as
Diabetes & Metabolism, 2003
To evaluate in France in 2001 the therapeutic management and control of diabetes and of modifiable cardiovascular risk factors in patients with type 2 diabetes receiving specialist care. Methods: The study was proposed to 575 diabetologists across France. The first 8 consecutive ambulatory patients with type 2 diabetes treated by oral antidiabetic drugs (OADs) and/or insulin attending for consultation with a diabetologist were eligible for inclusion in the survey. The following data were collected: demographics, diabetic and cardiovascular history, cardiovascular risk factors, blood pressure, last recorded measurements of HbA 1c and LDL cholesterol, and details of diabetes medication and cardiovascular medication. Results: 4, 930 patients (53% men) aged 62 ± 11 years were recruited by 410 specialists in diabetes care. The mean duration of diabetes was 12 ± 9 years. 71% of patients were treated with OADs, 18% with an OAD + insulin and 9% with insulin alone. Mean HbA 1c was 7.6 ± 1.6%; HbA 1c was ≤ 6.5% in 27% of patients, between 6.6% and 8% in 39% of patients, and > 8% in 34% of patients. Mean blood pressure was 140 ± 16/80 ± 9 mmHg. In the study population as a whole the target blood pressure (systolic BP < 140 mmHg and diastolic BP < 80 mmHg) was attained by 29% of patients. Among the 3, 085 patients (63%) treated for hypertension, this target was attained in only 23% of patients; 40% of patients treated for hypertension received one single antihypertensive treatment, 36% received 2 treatments and 24% received 3 treatments or more. Among the 1, 845 patients considered by the investigators as not having hypertension, the target blood pressure was attained by 39%. A measurement for LDL cholesterol was available in 4, 036 patients (82%). 58% of these patients had LDL cholesterol < 1.3 g/l, 29% had values between 1.3 and 1.6 g/l, and 13% had values > 1.6 g/l. 52% of patients were not receiving any lipid-lowering agents, 28% were treated with statins, 19% with fibrates, and 1% with statins + fibrates. LDL cholesterol was < 1.3 g/l in only 66% of the 646 patients with associated coronary heart disease. Conclusion: According to this large nationwide survey, the prevalence of cardiovascular risk factors remains high. Control of glycaemia, blood pressure and LDL cholesterol does not appear to be optimal. This is due in part to the severity of diabetes in these patients seen by specialists in diabetes care; however, both awareness and application of published recommendations need to be reinforced.
Type 2 diabetes and cardiovascular disease: reducing the risk
Journal of managed care pharmacy : JMCP, 2007
Type 2 diabetes (T2DM) is a major risk factor for developing cardiovascular disease (CVD). The growing epidemic of T2DM has contributed to CVD becoming the leading cause of morbidity and mortality in the United States. To review the pathophysiology of CVD; to demonstrate the interrelatedness of CVD, the metabolic syndrome, and T2DM; and to discuss treatment options that may reduce the risk of CVD in patients with T2DM. Recent data from the International Diabetes Federation show that the worldwide prevalence of T2DM is much higher than previously estimated. Managing patients with T2DM continues to severely burden the U.S. health care system. Furthermore, most costs associated with managing these patients are associated with treating CVD complications. Studies have shown that several agents can decrease the risk of CVD in patients with T2DM. To combat the diabetes epidemic, clinicians should treat patients with T2DM and prediabetes early and aggressively to control their metabolic dis...
Journal of Evolution of Medical and Dental Sciences, 2021
BACKGROUND India is one of the countries which has seen a rise in diabetes mellitus type 2 patient in last 2 decade. It is a known fact that patients suffering from diabetes mellitus have risk of developing many diseases like angiopathies and retionopathies. . The purpose of this study was to assess cardiovascular disease (CVD) risk factors and find out current clinical practices for prevention of cardiovascular diseases in diabetes type 2 patient attending diabetes out-patient department (OPD). METHODS This is a cross sectional study on 96 randomly selected patients who were diagnosed for diabetes mellitus type 2 for more than 3 months. CVD risk factors were studied using structured questionnaire about sociodemographic factors such as age, gender, family history, dyslipidaemia, hypertension, inactive physique, unsuitable food, excessive use of alcohol and all types of cigarettes; current medicines [anti-platelet medication, statins, angiotensin blocker, angiotensin converting enzym...
Cardiovascular protection in type 2 diabetes: time to ADVANCE management ACCORDing to the evidence
Research Reports in Clinical Cardiology, 2013
Individuals with type 2 diabetes mellitus are at very substantial risk of cardiovascular disease, and most will succumb to complications from premature coronary artery events. At the same time, the diabetic myocardium undergoes unique phenotypic alterations as a consequence of multiple structural and cellular injuries, which together form "diabetic cardiomyopathy." Attempts to curb risk through intensive modulation of glycemia and blood pressure have proven disappointing in preventing cardiovascular events, and potentially even dangerous. Conversely, prior to development of disease, there appears to be a linear relationship between risk parameters and events. These observations are likely the consequence of widespread vascular damage, which is present at the point that glycemic thresholds meet diagnostic criteria for diabetes. This is particularly true of the microcirculation. Interventions at the prediabetic stage have been consistent with this, where early intensive risk-factor modulation has been successful in preventing events and even regressing existing risk. Upstream, the force driving these pathologies is being overweight and obesity. High-risk individuals can be identified through simple body mass parameters, with confirmation of prediabetes/metabolic syndrome with further assessment of other metabolic parameters such as glucose and lipids. A number of novel pharmacotherapies may prove beneficial at this stage, and incretin-based therapies appear particularly promising in this respect. Similarly, bariatric procedures have shown remarkable improvements in metabolic and cardiovascular outcomes, but are clearly unsuitable as a population-wide strategy. Therapeutic lifestyle change and diet have consistently shown efficacy in reversing dysglycemia, lowering blood pressure, and optimizing cholesterol profiles. However, the longevity of these improvements is often limited, and alternative approaches therefore need to be considered. With an evolving and increasingly sophisticated evidence base for nutritional interventions, there is a clear window of opportunity to rescue these individuals from the clinical sequelae of diabetes and consequent cardiovascular complications.
Cardiovascular risk factors in type 2 diabetic patients: Multifactorial intervention in primary care
Kidney International, 2005
Cardiovascular risk factors in type 2 diabetic patients: Multifactorial intervention in primary care. Background. Cardiovascular disease is the main cause of morbidity and mortality in patients with type 2 diabetes mellitus (DM). Intervention on cardiovascular risk factors (CVRF) is essential to obtain clinical results reducing the excess of cardiovascular risk (CVR) in these patients. Methods. The objective of this study was to describe the association of type 2 DM with modifiable cardiovascular risk factors and the degree of control of these in a population of type 2 diabetics in attendance in primary care clinics, and also to establish prospectively whether an integral and multifactorial intervention on uncontrolled cardiovascular risk factors, carried out in conditions of routine clinical practice by applying an open protocol, could significantly reduce the estimated CVR according to the Framingham scale. The proposed intervention included both actions aimed at modifying habits, and pharmacologic intervention to achieve an optimum level of control in accordance with international recommendations for the objectives and treatment for type 2 diabetes. Results. A total of 3466 patients with a mean age of 58 ± 7.5 years were studied and followed-up for 1 year. Of these, 90.4% of patients had high blood pressure; 60.1% of men and 32.7% of women presented CVR >20% in 10 years according to the Framingham scale by categories. Intervention at 1 year of follow-up had achieved statistically significant reductions in blood pressure, glycated hemoglobin, and lipid levels, but not of patients' body weight. After 1 year of follow-up, 29% of males and 24% of women with a high CVR (>20%) at the start of the study presented reduced risk levels. Conclusion. The results of the study demonstrate that an integrated and multifactorial intervention in type 2 diabetic patients can achieve clinically significant reductions in CVR. However, conducted in effective conditions, it is not able to achieve optimum levels of control in spite of the initial proposal, possibly due to some degree of inertia in routine clinical practice. Type 2 diabetes is associated with a 2-to 4-fold increase in the risk of coronary heart disease. Furthermore, it is well known that cardiovascular diseases are the main