Cardiovascular risk assessment in patients with diabetes

Abstract Although patients with diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than individuals without diabetes, recent studies indicate that a significant part of patients are in a lower cardiovascular risk category. Men younger than 35 years, women younger tha...

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Main Authors: Marcello Casaccia Bertoluci, Viviane Zorzanelli Rocha
Format: Article
Language:English
Published: BMC 2017-04-01
Series:Diabetology & Metabolic Syndrome
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13098-017-0225-1
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spelling doaj-04417d0f35794b8ca0586f47cd0346132020-11-24T20:55:15ZengBMCDiabetology & Metabolic Syndrome1758-59962017-04-019111310.1186/s13098-017-0225-1Cardiovascular risk assessment in patients with diabetesMarcello Casaccia Bertoluci0Viviane Zorzanelli Rocha1Departamento de Medicina Interna da Faculdade de Medicina da, Universidade Federal do Rio Grande do Sul, UFRGSLipid Clinic, Heart Institute (InCor) University of Sao PauloAbstract Although patients with diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than individuals without diabetes, recent studies indicate that a significant part of patients are in a lower cardiovascular risk category. Men younger than 35 years, women younger than 45 years, patients with diabetes duration of less than 10 years without other risk factors have a much lower risk than patients who have traditional cardiovascular risk factors, and subclinical or established coronary artery disease (CAD). These patients are not risk equivalent as stated in previous studies. On the contrary, when in the presence of traditional risk factors or evidence of subclinical coronary disease (e.g. high coronary calcium score), the coronary risk is much increased and patients may be classified at a higher-risk category. Recent guidelines do not anymore consider diabetes as a CAD risk equivalent and recommend cardiovascular risk stratification for primary prevention. Stratification of diabetic patients improves accuracy in prediction of subclinical CAD, silent ischemia and future cardiovascular events. Stratification also discriminates higher from lower risk patients who may need intensive statin or aspirin prevention, while avoiding overtreatment in lower risk cases. It may also allow the clinician to decide whether to intensify risk reduction actions through specific newer drugs for glucose control such as SGLT-2 inhibitors or GLP-1 agonists, which recently have shown additional cardiovascular protector effect. This review addresses the assessment of cardiovascular disease risk using traditional and non-traditional cardiovascular risk factors. It also reviews the use of risk calculators and new reclassification tools, focusing on the detection of subclinical atherosclerosis as well as silent ischemia in the asymptomatic patients with diabetes.http://link.springer.com/article/10.1186/s13098-017-0225-1Cardiovascular diseaseRisk stratificationRisk assessmentType 2 diabetesRisk factors
collection DOAJ
language English
format Article
sources DOAJ
author Marcello Casaccia Bertoluci
Viviane Zorzanelli Rocha
spellingShingle Marcello Casaccia Bertoluci
Viviane Zorzanelli Rocha
Cardiovascular risk assessment in patients with diabetes
Diabetology & Metabolic Syndrome
Cardiovascular disease
Risk stratification
Risk assessment
Type 2 diabetes
Risk factors
author_facet Marcello Casaccia Bertoluci
Viviane Zorzanelli Rocha
author_sort Marcello Casaccia Bertoluci
title Cardiovascular risk assessment in patients with diabetes
title_short Cardiovascular risk assessment in patients with diabetes
title_full Cardiovascular risk assessment in patients with diabetes
title_fullStr Cardiovascular risk assessment in patients with diabetes
title_full_unstemmed Cardiovascular risk assessment in patients with diabetes
title_sort cardiovascular risk assessment in patients with diabetes
publisher BMC
series Diabetology & Metabolic Syndrome
issn 1758-5996
publishDate 2017-04-01
description Abstract Although patients with diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than individuals without diabetes, recent studies indicate that a significant part of patients are in a lower cardiovascular risk category. Men younger than 35 years, women younger than 45 years, patients with diabetes duration of less than 10 years without other risk factors have a much lower risk than patients who have traditional cardiovascular risk factors, and subclinical or established coronary artery disease (CAD). These patients are not risk equivalent as stated in previous studies. On the contrary, when in the presence of traditional risk factors or evidence of subclinical coronary disease (e.g. high coronary calcium score), the coronary risk is much increased and patients may be classified at a higher-risk category. Recent guidelines do not anymore consider diabetes as a CAD risk equivalent and recommend cardiovascular risk stratification for primary prevention. Stratification of diabetic patients improves accuracy in prediction of subclinical CAD, silent ischemia and future cardiovascular events. Stratification also discriminates higher from lower risk patients who may need intensive statin or aspirin prevention, while avoiding overtreatment in lower risk cases. It may also allow the clinician to decide whether to intensify risk reduction actions through specific newer drugs for glucose control such as SGLT-2 inhibitors or GLP-1 agonists, which recently have shown additional cardiovascular protector effect. This review addresses the assessment of cardiovascular disease risk using traditional and non-traditional cardiovascular risk factors. It also reviews the use of risk calculators and new reclassification tools, focusing on the detection of subclinical atherosclerosis as well as silent ischemia in the asymptomatic patients with diabetes.
topic Cardiovascular disease
Risk stratification
Risk assessment
Type 2 diabetes
Risk factors
url http://link.springer.com/article/10.1186/s13098-017-0225-1
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