Cardiologists play a role in treating patients with diabetes

Cardiologists and endocrinologists should increase cooperation to combat diabetes and its complications.

Issue: April 2006

Cardiologists may be treating an increasing number of patients affected by the escalating diabetes epidemic.

Alan Brown, MD, director of the Midwest Heart Disease Prevention Center in Naperville, Ill. and clinical associate professor of medicine at Loyola University in Maywood, Ill., said diabetes is a major health problem in the United States and the majority of patients affected by this epidemic will experience cardiovascular complications. Brown spoke at the 55th Annual Scientific Sessions of the American College of Cardiology, held recently in Atlanta.

Although endocrinologists typically treat patients with diabetes, Brown suggested increased cooperation between cardiologists and endocrinologists may be the best way to fight this disease and its complications.

Diabetes and CVD

Brown said it is imperative that cardiologists be involved in the management of diabetes. “Most health care professionals know that CVD is the leading cause of morbidity and mortality in patients with diabetes,” he said. “But patients with diabetes are often unaware of this. They are more worried about losing their limbs and kidney failure. They don’t realize that the most prevalent risk factor for CVD in the United States today is diabetes.”

The statistics for patients with diabetes are alarming. According to Brown, 80% of diabetes-related deaths will involve cardiovascular complications and 75% of all diabetes-related hospitalizations are from cardiovascular complications.

A high percentage of patients treated for CAD or diabetes may have further undiagnosed health problems. “About 50% of patients treated for diabetes will also have preexisting CAD, and one-third of all patients who present with MI will have undiagnosed diabetes,” Brown said.

Diagnosis

The prevalence of undiagnosed diabetes may be greater than many doctors and patients realize. A patient may have diabetes for years before the diagnosis is made, and the disease may be causing complications in the interim. “From the time a patient develops type 2 diabetes, it may take 10 to 14 years to make a diagnosis,” Brown said. “During this time, the patients may suffer more CVD complications. We need to be more vigilant to reduce this gap.”

Brown also noted that since an increased risk of vascular complications often precedes the development of hyperglycemia, patients often present for cardiovascular complications before diabetes has developed or is diagnosed.

Preventing complications

Brown said despite the grim statistics, he is encouraged that if doctors apply current preventive guidelines and therapies, a high number of cardiovascular complications in patients with diabetes could be prevented.

Brown recommended that when a patient is diagnosed with diabetes, he or she should be started on statin therapy. “Statins can cut the patient’s risk for cardiovascular complications dramatically by improving cholesterol levels,” he said.

Aspirin therapy also appears to be beneficial for patients with diabetes. “A recent study showed that patients with diabetes have a 17% reduction in CVD events just through aspirin therapy,” Brown said. “This is something we don’t always think about for patients with diabetes, especially if they don’t have CAD. But it can be important to all patients with diabetes.”

Brown recommended ACE inhibitors to reduce blood pressure in all patients with diabetes. “Even in normotensive patients with diabetes, the CVD risk can be reduced with ACE inhibitors,” he said. “Even a little improvement in blood pressure control translates to a big reduction in risk in patients with diabetes. The goal is to get the patient’s blood pressure below 130 mm Hg/80 mm Hg.”

Improvements in diet and exercise should be recommended for all patients with diabetes. “When all risk factors – including lipids and blood pressure – are managed, there is a remarkable reduction in CVD events,” Brown said. “We can reduce the absolute risk of CVD events in patients with diabetes by up to 20% simply by attending to the details. We could have a major impact on the diabetes epidemic this way.” – by Jay Lewis

For more information:

Brown A. The epidemic of diabetes: Prevention of cardiovascular disease. Presented at the 55th Annual Scientific Sessions of the American College of Cardiology. March 11-14, 2006. Atlanta.