Diabetes, prediabetes and cardiovascular risk
Linda G Mellbin1, Matteo Anselmino, Lars Rydén
1Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. linda.mellbin@karolinska.se
Summary
Undiagnosed glucose perturbations like impaired glucose tolerance or diabetes are common in cardiovascular disease patients. Early screening and collaborative management with cardiologists and diabetologists improve outcomes.
Area of Science:
- Endocrinology
- Cardiology
- Public Health
Background:
- Rising incidence of diabetes and prediabetes, linked to cardiovascular disease (CVD), poses a significant public health challenge.
- Cardiovascular mortality and morbidity are increased by undetected glucose metabolism issues, including impaired glucose tolerance and diabetes.
- A gap exists in cardiologists' understanding of the prevalence and impact of glucose perturbations in CVD patients.
Purpose of the Study:
- To highlight the high prevalence of undiagnosed glucose perturbations in patients with coronary artery disease.
- To emphasize the need for routine screening of glucose metabolism in all cardiovascular disease patients.
- To advocate for integrated, multifactorial treatment strategies involving cardiologists and diabetologists.
Main Methods:
- Screening of patients with stable and unstable coronary artery disease using the oral glucose tolerance test.
- Analysis of the association between glucose perturbations and cardiovascular mortality/morbidity.
- Review of European guidelines for managing diabetes, prediabetes, and cardiovascular disease.
Main Results:
- Approximately two-thirds of coronary artery disease patients exhibit previously unknown impaired glucose tolerance or diabetes upon screening.
- Both impaired glucose tolerance and diabetes are independently associated with increased cardiovascular mortality and morbidity.
- Current cardiological practice often overlooks the necessity of aggressive management of underlying metabolic disorders.
Conclusions:
- Routine oral glucose tolerance testing is recommended for all patients with cardiovascular disease manifestations.
- Effective management requires a transprofessional collaboration between cardiologists and diabetologists.
- Target-driven, multifactorial treatment approaches are crucial for improving prognosis in patients with comorbid diabetes and cardiovascular disease.
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