Prevention of Vascular Complications in Patients with Diabetes Mellitus

Diabetes, hypertension, and hyperlipidemia are interrelated disorders conferring an increased risk of vascular events and endothelial dysfunction. Patients with type 2 diabetes (T2DM) are often diagnosed with some form of cardiovascular disease (CVD) such as myocardial infarction, atrial fibrillation, heart failure, peripheral arterial disease, and coronary artery disease. Evidence from randomized controlled clinical trials points to the need for comprehensive risk management and aggressive treatment for patients with concomitant diabetes and CVD.

The American Heart Association and American College of Cardiology (AHA/ACC) 2006 guidelines for secondary prevention recommend a number of evidence-based measures. These include smoking cessation; blood pressure control (including a blood pressure goal of <130/80 mmHg in patients with diabetes or chronic kidney disease); lipid management (including an LDL-C goal of <100 mg/dL); physical activity; weight management; management of hyperglycemia (with a goal HbA1c of <7%); appropriate antiplatelet/anticoagulant therapy; therapy with ACE inhibitors, ARBs and/or aldosterone blockers (including use in selected patients regardless of blood pressure levels); and use of beta blockers in patients with history of myocardial infarction or acute coronary syndrome.

In this conversation, three endocrinologists, Dr. Paul Jellinger, Dr. Joseph Torre and Dr. Vijay Nambi, join Dr. Carlos Hamilton, Jr. to discuss current issues primarily surrounding the prevention of vascular complications in diabetic patients. Related References / Reading:

Related References/Reading:

  1. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update: Endorsed by the National Heart, Lung, and Blood Institute. Sidney C. Smith, Jr, Jerilyn Allen, Steven N. Blair, et al. Circulation 2006;113;2363-2372.
  2. Sipahi I, Tuzcu EM, Schoenhagen P, et al. Effects of normal, pre-hypertensive, and hypertensive blood pressure levels on progression of coronary atherosclerosis. J Am Coll Cardiol. 2006;48:833-8.