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7 - Management of increased cardiovascular risk

Published online by Cambridge University Press:  09 August 2009

Jill Hill
Affiliation:
Birmingham East and North Primary Care Trust
Molly Courtenay
Affiliation:
University of Reading
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Summary

Traditionally, the management of both type 1 and type 2 diabetes has been focused on glycaemic control. However, particularly in type 2 diabetes, these patients are at very much increased cardiovascular risk, which is illustrated by the observation by Haffner et al. (1998) that someone with type 2 diabetes has a similar risk of having a myocardial infarction as someone without diabetes who has already had a myocardial infarction. Life expectancy of someone with type 2 diabetes, if diagnosed between 40 and 60 years of age, is reduced by about 5–10 years. Mortality rate is increased more than twofold; fatal coronary heart disease is increased two- to fourfold; fatal stroke is increased two- to threefold; coronary heart disease is increased two- to threefold; cerebrovascular disease is increased more than twofold; peripheral vascular disease is increased two- to threefold; and cardiac failure is increased two- to fivefold (Krentz and Bailey, 2001).

These greatly increased risks in type 2 diabetes result from the clustering of risk factors seen in patients with this condition, particularly hypertension and dyslipidaemia. The UK Prospective Diabetes Study (UKPDS) Group (1998) showed that improved blood glucose had relatively little impact on the incidence of cardiovascular complications, but reducing blood pressure reduced risk significantly for these complications.

The Steno-2 study (Gaede et al., 2003) demonstrated that a multifactorial approach to target all major risk factors resulted in a much greater reduction in cardiovascular endpoints.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

,American Diabetes Association (2006) Standards of medical care in diabetes in 2006. Diabetes Care 29(Suppl. 1): S4–42.Google Scholar
Brenner, B. M., Cooper, M. E., Zeeuw, D.et al. (2001) The Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan study (RENAAL). New England Journal of Medicine 345: 861–9.CrossRefGoogle Scholar
Colhourn, H. M., Betteridge, D. J., Durrington, P. N.et al. (2004) Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative AtoRvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 364: 685–96.CrossRefGoogle Scholar
Collins, R., Armitage, J., Parish, S.et al. and the ,Heart Protection Study Collaborative Group (2002) MRC/BHF Heart Protection Study (HPS) of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 360: 7–22.Google Scholar
Gaede, P., Vedel, P., Larsen N. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. New England Journal of Medicine 2003 348: 383–93.CrossRefGoogle ScholarPubMed
Haffner, S. M., Lehto, S., Ronnemaa, T.et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New England Journal of Medicine 1998 339(4): 229–34.CrossRefGoogle ScholarPubMed
Hansson, L., Zanchetti, A., Carruthers, S. G.et al. (1998) Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 351: 1755–62.CrossRefGoogle ScholarPubMed
Holman, R., Turner, R., Stratton, I.et al. (1998) Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. British Medical Journal 317: 713–20.Google Scholar
,Joint British Societies [British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, Stroke Association] (2005) JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 91(Suppl. V): v1–52.CrossRefGoogle Scholar
Keech, A., Simes, R. J., Barter, P. et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 366 2005: 1849–61.Google ScholarPubMed
Krentz, A. J., and Bailey, C. J. (2001) Type 2 Diabetes in Practice. London: Royal Society of Medicine Press.Google Scholar
Parving, H. H., Lehnert, H. and Mortensen, J. B. (2001) Irbesartan in microalbuminuria in type II (IRMA II). New England Journal of Medicine 345: 870–8.CrossRefGoogle Scholar
,UK Prospective Diabetes Study (UKPDS) Group (1998) Tight blood pressure (BP) control and risk of macrovascular complications in type 2 diabetes: UKPDS 38. British Medical Journal 317: 703–11.CrossRefGoogle Scholar

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