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Optimizing cardiovascular outcomes in diabetes mellitus.
1Cardiovascular Research Institute, University of Vermont, Colchester, Vermont 05446, USA. burton.sobel@uvm.edu
The American Journal of Medicine
|September 14, 2007
Summary
Patients with diabetes face higher cardiovascular disease risks and poorer outcomes. Management strategies focusing on risk factors and specific medications, beyond glucose control, are crucial for improving survival and reducing events.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Diseases
Background:
- Diabetes mellitus significantly elevates cardiovascular disease (CVD) risk, leading to reduced life expectancy and poorer prognosis post-event.
- Pathogenesis involves insulin resistance, endothelial dysfunction, dyslipidemia, chronic inflammation, and altered coagulation/fibrinolysis.
Framework:
- Multidisciplinary statements address macrovascular disease in diabetes, emphasizing risk assessment and management beyond glycemic control.
- Focus on cardiovascular risk factors and the impact of diabetes medications on macrovascular outcomes.
Implementation:
- Aggressive management of established risk factors (statins, antihypertensives) reduces cardiovascular events.
- Screening for and intervening on additional CVD risk factors is essential for diabetic patients.
- Hyperglycemia correction aids macrovascular event reduction, though less directly than for microvascular complications.
Implications:
- Some insulin sensitizers and thiazolidinediones (e.g., pioglitazone) show potential in reducing cardiovascular events and improving survival.
- These agents offer metabolic benefits that may translate to improved cardiovascular risk profiles in patients with diabetes and atherosclerosis.
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