In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

Cardiovascular disease prevention in diabetes - what works and what does not?

Session presentations

  • Antiplatelet therapy. Presented by C Patrono (Rome, IT) congress 365
  • Glycemic control. Presented by N Marx (Aachen, DE) congress 365
  • Statins. Presented by K K Ray (London, GB) congress 365
  • Blood pressure management. Presented by F Martinez (Cordoba, AR) congress 365
Cardiovascular Pharmacology and Pharmacotherapy


Diabetic patients are a specific population in cardiovascular disease trials. The benefit/risk profile of drugs in different indications could be different in diabetic patients. Usually the data in this population come from subgroup analyses of big outcome trials.

ANTIPLATELET THERAPY:
The use of aspirin in diabetic patients has been a subject of controversy in recent years and different guidelines give different recommendations. There is no doubt that diabetic patients with a cardiovascular event should be on aspirin; what remains a matter of debate is the need for aspirin in primary prevention in diabetic patients. It seems from basic studies that aspirin acts differently in diabetics meaning the benefit/risk ratio is smaller. Currently, aspirin is not recommended in primary prevention in diabetic patients if there is not another risk factor.

GLYCEMIC CONTROL
Glucose control and cardiovascular risk: patients who benefit most from an intensive glucose lowering therapy are those who have a low HbA1C at baseline, those who have no previous cardiovascular disease and those who have a short duration of diabetes. Hypoglycaemic events in diabetic patients are a risk factor for future cardiovascular events (odds ratio 1.79). An acute hypoglycaemic episode reduces extracellular glucose and potassium, favouring ventricular arrhythmias. Ongoing clinical trials of antidiabetic drugs will provide more evidence on the effect of glycaemic control on cardiovascular risk in diabetes. The major cardiovascular safety trials are CAROLINA (Linagliptin), TECOS (Sitagliptin), SAVOR TIMI 53 (Saxagliptin), EXAMINE (Alogiptin), and LEADER (Liraglutide).

STATINS
Statins reduce cardiovascular diseases in general and they are safe. PROVE I study results showed a safe profile of high dose of atorvastatin (80mg daily). Diabetes doubles the risk of cardiovascular disease. Different trials have shown that statins reduce cardiovascular events consistently in the diabetic population. It can be concluded that statins provide a similar proportional reduction in cardiovascular risk among those with diabetes as in patients without diabetes, and the magnitude of the benefit is related to the degree of LDL cholesterol reduction.

BLOOD PRESSURE MANAGEMENT
The increasing incidence of diabetes and hypertension is almost parallel to the association of both diseases. Patients with systolic blood pressure >140mmHg and diastolic blood pressure >90 mmHg at diagnosis should receive pharmacological therapy in addition to lifestyle changes. A regimen with ACE inhibitors or ARBs is a first step regimen but kidney function and serum potassium levels should be closely monitored. According to Cardiorenal outcomes in diabetes study results (ALTITUDE), Aliskiren is not recommended for blood pressure control in diabetic patients.

References


723

SessionTitle:

Cardiovascular disease prevention in diabetes - what works and what does not?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.