Global management of high risk patients: Integrated primary cardiovascular prevention in diabetics

Abstract

Diabetes mellitus is a pivotal risk factor for cardiovascular disease and a negative prognostic element in cardiovascular patients. The incidence of cardiovascular diseases in diabetics is 3-to-6 times higher than in non-diabetics, and cardiovascular pathology progresses more quickly in the former, thus constituting their major determinant of mortality. In diabetics 65–75% of deaths are caused by cardiovascular factors, and following a major coronary event diabetes increases about 2–3 times the all-cause mortality risk in affected people. Diabetes is also associated with a triple risk of death from coronary heart disease and a 10–12-fold increase in risk of mortality from coronary heart disease if compared with people with neither diabetes mellitus nor coronary heart disease. A healthy lifestyle, including cessation of smoking, suitable exercise, correct diet, appropriate weight loss and stress control, should be recommended to every subject in the perspective of cardiovascular prevention. Additional specific recommendations for diabetics in the primary prevention of cardiovascular events include accurate individually tailored glycemic control (general target: HbA1c < 7%), strict blood pressure treatment (target: < 130/80 mmHg), optimal lipid lowering regimen (target: LDL-C < 100 mg/dl; < 70 mg/dl in very high risk diabetics), antiplatelet therapy with aspirin (dosage: 75–150 mg per day). The current and future objective for health operators and systems is that of harmonically integrating multiple risk factor management not only with stringent treatment goals, but also with selective attention to the specific needs and fundamental values of every diabetic person encountered in daily clinical practice.