Consider diabetes as a cardiac condition

American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress

Patients with type 2 diabetes often present with not only metabolic health problems, but also cardiovascular co-morbidities, according to David S. H. Bell, MD, FACE, FACP, clinical professor of medicine at the University of Alabama School of Medicine, Birmingham.

Therefore, “when you see a patient with diabetes, automatically assume they have heart disease from the beginning and treat them as a cardiac patient,” he told Endocrine Today.

Established relationship

Sixty-five percent of people with type 2 diabetes die of cardiovascular disease, 2/3 of those from ischemic heart disease and 44% of people admitted to the hospital in the United States with heart failure have diabetes, according to Bell. If a patient with type 2 diabetes is over 50 years old and female, they have a four-fold increased risk of heart disease. If the patient is male, the risk of heart disease is two-fold, he said.

Bell, also an Endocrine Today Editorial Board member, said that the patient with type 2 diabetes “has as much chance of having a MI as a non-diabetic patient who has already had one.” The mortality rate of a patient with diabetes who has experienced a MI is approximately double that of the non-diabetic patient.

There are more diabetic individuals who are resistant to aspirin therapy, but unfortunately there is no convenient way of detecting aspirin resistance in people with diabetes, according to Bell. Furthermore, he stated that “we ought to be starting vasodilating beta blockers a lot earlier in patients with diabetes.” Everyone who has diabetes should be on statin therapy, he suggested.

Regulation of HbA1c is also important. For every 1% the HbA1c level is above 5 there is a 26% increase in cardiovascular events, but for every 1% the HbA1c level is above 7 there is a 40% increase, according to Bell.

“So clearly you want the HbA1c level as low as possible without getting hypoglycemia,” he said. “In patients with type 2 diabetes, we need to be below 6.5.” – by Tara Grassia

For more information:
Bell DSH. Diabetes: a cardiac condition. Presented at: American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress; May 14-18, 2008; Orlando, Fla.