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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Online Access: | http://link.springer.com/article/10.1186/s13098-017-0225-1 |
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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 |
work_keys_str_mv |
AT marcellocasacciabertoluci cardiovascularriskassessmentinpatientswithdiabetes AT vivianezorzanellirocha cardiovascularriskassessmentinpatientswithdiabetes |
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1716792012215156736 |