ADA and AHA: Greater diabetes and CVD prevention efforts needed

The joint statement calls for all providers to assess patients for global risk factors associated with diabetes and cardiovascular disease.

The growing prevalence of obesity threatens recent gains to prevent and control chronic disease, and overweight or obese people deserve clinical attention, according to a joint statement by the American Diabetes Association and the American Heart Association.

The statement, prepared by Robert H. Eckel, MD, of the University of Colorado at Denver and Health Sciences Center, and colleagues from the ADA, AHA and Mayo Clinic in Rochester, Minn., appears in Circulation.

Two-thirds of American adults are now overweight or obese, according to the statement.

Eckel and colleagues addressed metabolic syndrome. Although many organizations and individuals accepted metabolic syndrome, which was constructed to describe metabolic abnormalities associated with insulin resistance, others questioned the clinical use of the syndrome. The ADA and AHA are concerned a dispute will lead to a reduction in the trend of CVD prevention approaches and wanted to confirm both organizations’ commitments to reducing diabetes and CVD. The joint statement stresses the importance of identifying and treating risk factors, including dyslipidemia.

CVD-diabetes link

Although heart disease and stroke rates steadily declined and cancer rates mortality rates remained stable, diabetes prevalence has escalated.

CVD is the leading cause of morbidity and mortality among individuals with diabetes. Adults with diabetes are two to four times more likely to develop CVD compared with adults who do not have diabetes. In addition, people with diabetes are more likely to have dyslipidemia and hypertension.

A reasonable theory suggests that excess weight leads to diabetes, dyslipidemia and hypertension, which leads to CVD, said the researchers. However, many studies show that hyperglycemia at prediabetic levels is a risk factor for CVD. In addition, intra-abdominal, or visceral, fat may be more detrimental than overall BMI or weight. The relationship between hyperglycemia and lipid metabolism is complex. Obesity without glucose intolerance is associated with CHD, HF and stroke.

Assessing risk

The researchers noted emerging evidence suggesting that simply monitoring a patient’s blood glucose level, BP, LDL cholesterol levels and noting the presence of obesity and whether a person smokes could be sufficient in initiating interventions to identify or prevent emerging CVD and diabetes. The role of the effects of each risk factor, the hierarchy of the risk factors, the inclusion of other risk factors and the relationships between the risk factors are still being defined. However, the ADA and AHA recommend that physicians be aware of these factors because borderline abnormalities may even suggest future problems, especially if multiple abnormalities are present.

Lifestyle modifications can drastically reduce a person’s progression to type 2 diabetes.

Eckel stressed the importance of prevention for obesity and CVD and diabetes in people who are already obese. “This begins and continues with lifestyle and pharmacological and/or surgical intervention when indicated,” he told Cardiology Today. – by Lauren Riley

For more information:

• Merz CNB, Shaw L, Reis SE, et al. Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol. 2006;47:21S-29S.
• Bugiardini R, Merz CNB. Angina with “normal” coronary arteries: a changing philosophy. JAMA.2005;293:477-484.