Cardiovascular risk prevention in diabetic patients

پنجمين كنگره بين المللي پيشگيري از بيماريهاي قلب و عروق

7 الي 9 مهر 1395، شيراز - ايران

Presentation Type: Speech

Sixty five percent of people with diabetes in the US die from heart attacks or strokes. Unfortunately, most of them are not aware of the link between diabetes and heart disease and the things they can do to reduce their risks. Studies using routine electrocardiographic exercise treadmill testing, ambulatory electrocardiographic monitoring, and myocardial perfusion scans have each shown that the prevalence of silent ischemia varies between 20%-40% in asymptomatic patients with type 2 diabetes. Indeed, atherosclerotic cardiovascular disease (ASCVD) defined as acute coronary syndromes (ACSs), a history of myocardial infarction (MI), stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin is the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes.
However, the risk of a second cardiac event (cardiac death or another infarction) in a diabetic patient is about 50% over a 10-year period which is more than twice the corresponding risk of a non-diabetic experiencing a first infarction.
The recent report by the Diabetes Prevention Program Research Group shows that a program of care based on lifestyle management has a significantly favorable impact on the incidence of type 2 diabetes in patients who have impaired glucose tolerance but no overt diabetes. Thus, both patients with type 2 diabetes and those with prediabetes, are uniquely positioned to take advantage of programs which should include exercise training, dietary management and patient education services.
Furthermore, in all patients with diabetes, cardiovascular risk factors should be systematically assessed. These risk factors include dyslipidemia, hypertension, smoking, a family history of premature coronary disease, and the presence of albuminuria. In asymptomatic patients, routine screening for coronary artery disease is not recommended as it does not improve outcomes as long as atherosclerotic cardiovascular disease risk factors are treated.
Investigations for coronary artery disease is recommended in the presence of any of the following: atypical cardiac symptoms (e.g., unexplained dyspnea, chest discomfort); signs or symptoms of associated vascular disease including carotid bruits, transient ischemic attack, stroke, claudication, or peripheral arterial disease; or electrocardiogram abnormalities (e.g., Q waves).
Numerous studies have shown the efficacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with diabetes and large benefits are seen when multiple risk factors are addressed simultaneously.
Recent figures show that life expectancy in birth have increase in Iranian women to 80.7 years. While this is a good new regarding better living standards in Iran , but its forecasts a large burden of non communicable diseases in future specially cardiovascular and cerebrovascular diseases . The most common cause of death among Iranian women are currently these two and this trend might increase further with aging. Regarding disability cardiovascular diseases rank third and cerebrovascular disease rank 6th in Iranian women .
The major contributing factors are dietary risks , low physical activity , uncontrolled blood sugar , high blood pressure and hyperlipidemia . Obesity as in many other countries is more prevalent among Iranian ladies . Tobacco use in Iranian women is less than male (4% vs 26%0 but the trend is increasing much faster in women . Water pipe smoking in women have increased dramatically in recent years in special .
Importance of healthy aging as well as the early childhood development in prevention of the current and ongoing epidemic of CVDs should be emphasized.

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