Cor Vasa 2011, 53(4-5):242-248 | DOI: 10.33678/cor.2011.054

Diabetes mellitus and cardiovascular diseases

Terezie Pelikánová

Centrum diabetologie, Institut klinické a experimentální medicíny, Praha, Česká republika

Cardiovascular (CV) complications are the most common cause of death in patients with diabetes. Management of hyperglycemia significantly reduces the risk of development and progression of microvascular complications of diabetes whatever the stage of the disease and irrespective of the therapeutic modality used. The importance of management of hyperglycemia in terms of CV risk reduction continues to be a matter of debate. In epidemiological studies hyperglycemia, in particular postprandial hyperglycemia, has been clearly established as an independent risk factor for CV mortality and morbidity. Interventional studies published over the last two years have shown the need for an individualized approach to patients. A strategy shown to have a significantly beneficial effect on CV risk reduction is tight diabetes control, particularly in patients in primary CV prevention early after they have been diagnosed to have diabetes; in these cases, a role is played by what is called "metabolic memory". By contrast, excessively aggressive treatment of hyperglycemia in individuals with advanced diabetes-related complications and already overt CV disease will increase the risk for CV death, presumably due to development of hypoglycemic episodes.
A number of comprehensive measures are currently available in the prevention and treatment of CV disease in patients with diabetes.
In addition to management of hyperglycemia, these measures include management of other modifiable risk factors such as treatment of hypertension, dyslipidemia and, possibly, treatment of obesity, and antiplatelet therapy. Patients with hyperglycemia have their therapeutic goals "tailored" to meet their specific needs. Target HbA1c levels in individuals at low CV risk are below 4.5%. The levels are less strict (HbA1c below 6%) in those in secondary prevention, with patient safety (absence of hypoglycemia) being the most important consideration. Preference is given to gradual improvement of diabetes control. The drug of first choice in patients with type 2 diabetes is metformin (started immediately after the diagnosis has been established) in combination with lifestyle measures. If monotherapy fails to provide adequate control, other oral hypoglycemic agents, incretins or insulin can be added. Given the uncertainty regarding the appropriateness of use of hypoglycemic agents in terms of long-term prognosis, the procedure is fairly liberal. The method of choice in patients with type 1 diabetes is an intensified insulin regimen. Patient education and regular screening of potential complications of diabetes make an integral part of comprehensive management.

Keywords: Diabetes mellitus; Cardiovascular diseases; Hyperglycemia; Metformin; Insulin

Published: April 1, 2011  Show citation