A combination of preventive and intervention management strategies are needed to reduce the morbidity and mortality of cardiovascular disease (CVD) in diabetic patients. Fundamental to the preventive approach is the position that diabetes constitutes a coronary heart disease (CHD) risk equivalent and therefore requires aggressive screening and management of those cardiovascular risk factors known to contribute to CVD. These include hypercholesterolemia (raised LDL-cholesterol), atherogenic dyslipidemia, hypertension, cigarette smoking, hyperglycemia, and the procoagulant state. In addition because the genesis of CVD in diabetic subjects begins prior to diagnosis, individuals at increased risk for diabetes should be targeted for CVD risk factor screening and management according to standard recommendations. At the intervention level, it is recommended that diabetic individuals without known coronary heart disease and with two other CVD risk factors undergo stress testing. Finally, in the past 5 years significant advances have occurred in our understanding and management of acute myocardial infarction and of revascularization strategies, and these have now been shown to reduce the morbidity and mortality caused by established coronary heart disease in diabetic subjects.
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism