AHA, ADA release joint statement on prevention of CVD in people with diabetes

The groups collaborated to lay out extensive guidelines on management of diabetes to lower CVD risk.

Issue: February 2007

The American Heart Association and the American Diabetes Association have released a joint statement designed to prevent the high risk for cardiovascular disease in people with diabetes.

“It was an effort to ensure that the recommendations from the ADA, the leading health organization representing people with diabetes, and the AHA, the leading organization with regards to heart disease, were perfectly aligned,” said John B. Buse, MD, PhD, president-elect of the ADA and chief of endocrinology at the University of North Carolina, Chapel Hill. Buse was one of the authors of the joint statement.

The AHA/ADA statement is the first of many to come that will recap aggressive ways to prevent and treat risk factors in an effort to curb the high rate of death associated with CVD. The statement was published concurrently in Circulation and Diabetes Care.

CVD risk

The incidence of diabetes is increasing every year, and heart disease kills about 70% to 80% of people with diabetes, according to Buse. The first myocardial infarction often occurs in people who have never had any symptoms of heart disease; one-third of MIs are fatal.

“So, for a substantial proportion of people with diabetes, their first symptom of heart disease will rapidly result in death,” Buse said. “This guideline really focuses on primary prevention of CVD to prevent that first heart attack.”

According to George L. Bakris, MD, professor of medicine and director of the hypertension unit at the University of Chicago Pritzker School of Medicine, the risk for CVD is serious. It is substantially higher in people with diabetes, anywhere from sixfold to 10-fold higher, than the general population, he said.

“In general, there is broad agreement across 99% of the recommendations, and in a couple areas where there is disagreement there is now a feeling that if you do it the ADA way that’s fine, and if you do it the AHA way that’s fine, too,” Buse said. “The most important thing is that you do it.”

Overall, the statement was a collaboration to bring the two organizations to a consolidated agreement in terms of what data are already known and what to do about the problem in the future, according to Bakris.

“It’s kind of like a greatest hits album, if you will. The statement took what the ADA and AHA are already saying and put it into a document that’s speaking in the same voice,” Bakris said.

Points in managing CVD risk

“As far as recommendations go, it’s not chock full of new recommendations with regard to managing cardiovascular risk and diabetes,” Buse said. The recommendations were based on already known evidence, including data from clinical trials.

The statement goes into detail about comprehensive risk management, lifestyle management, BP, lipids, tobacco, antiplatelet agents, glucose management and type 1 diabetes.

“Lifestyle measures such as medical nutrition therapy and aerobic exercise have been demonstrated to modify lipids and reduce blood pressure and are integral to the management of glycemia and weight control,” the statement reads. “Although lifestyle intervention in patients with type 2 diabetes has traditionally focused almost exclusively on weight loss, most experts in the field today believe the major focus of lifestyle intervention should be on improving glycemic control and controlling other major CVD risk factors.”

These factors include weight control, re-educating patients about healthy food selection and at least 150 min of moderate physical activity or 90 min of vigorous exercise a week.

As for proper medical nutrition therapy, the statement suggests that saturated fats comprise <7% of energy intake, dietary cholesterol <200 mg/day and trans fat <1%, to achieve reductions in LDL cholesterol; total dietary fat intake about 25% to 35% of total calories; >14 g of fiber per 1,000 calories consumed; no more that one or two alcoholic drinks per day; and a reduction of sodium intake to 1,200 to 2,300 mg/day.

Where they differ

The statement reads, “Although both the ADA and the AHA support efforts to raise HDL cholesterol in high-risk patients when these levels are reduced, there is one difference in the organizations’ recommendations. The ADA specifies therapeutic goals for HDL cholesterol (>40 mg/dL, with consideration of a higher target of >50 mg/dL in women), whereas the AHA advocates efforts to raise HDL cholesterol without specifically designating goals of therapy.”

The parties also disagreed on type 2 diabetes and metabolic syndrome. “It is still important to realize that unresolved issues still exist relating to the assessment of risk in many people with diabetes. For example, the AHA and the National Heart, Lung, and Blood Institute have issued a statement on management of metabolic syndrome and maintain that with regard to risk for CVD, metabolic syndrome and type 2 diabetes can coexist in one person. The ADA, in contrast, contends that after type 2 diabetes is present, metabolic syndrome no longer pertains because CVD risk factors characteristic of metabolic syndrome are largely subsumed in the type 2 diabetes syndrome,” the statement read.

“In the general community, I hope there’s greater awareness of heart disease and if you have diabetes that heart disease is what is likely to get you down. That creates an opportunity that by focusing on risk factors and reduction, you should be able to prolong your life,” Buse said. –by Katie Kalvaitis

For more information:
Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus. Diabetes Care. 2007;30:162-172