Cardiovascular complications in diabetes

Abstract

Introduction: Diabetes is a disease with a high prevalence and macrovascular complications of diabetes are among the most feared consequences of diabetes, with high costs. Constant evolution of knowledge in this area justifies a new review of the literature on this topic. Objectives: To define the goals of primary and secondary prevention of macrovascular complications in diabetic patients, based on the best available scientific knowledge. Methods: A review of guidelines, recommendations, randomized controlled trials and meta-analyses of prevention of macrovascular complications of diabetes was performed. Results: In diabetic patients it is necessary to manage all risk factors of vascular disease. For primary prevention, lifestyle modifications are of great importance. Diet should be modified to reduce fat, salt and caloric intake, and regular exercise should be promoted. Smokers should be encouraged to quit. Glycemic levels should be controlled to achieve a HbA1C<7% (or <6%, if possible). Blood pressure should be <130/80mmHg. The recommended lipid levels are LDL-c<100mg/dL, HDL-c>40 mg/dL in men and >50mg/dL in women, and triglycerides<150mg/dL. In secondary prevention, the electrocardiogram is the only examination recommended as a screening method for cardiac complications and should be performed every two years in the diabetic patient ³50 years with at least one additional risk factor. Other examinations should be performed only in the presence of electrocardiogram changes and/or the presence of symptoms suggesting cardiovascular disease. Patients with clinical cardiovascular disease should begin pharmacological treatment and lifestyle changes to achieve an optimal level of LDL-c<70mg/dL, as well as triglycerides <150mg/dL and HDL-c>40mg/dL in men and >50mg/dL in women. Should the patient need treatment with oral coagulants, the recommended INR is between 2 and 3. The remaining recommendations for the management of other risk factors are similar to those for primary prevention. Conclusions: A multifactorial approach is important for both primary and secondary prevention of macrovascular events as it results in clear improvements in the quality of life of the diabetic patient by reducing associated cardiovascular morbidity.