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Diabetes: Difference between revisions
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===Treatments to reduce cardiovascular risk=== | ===Treatments to reduce cardiovascular risk=== | ||
To reduce the risk of cardiovascular disease, the followings are needed to be considered: | |||
a) the prevention of the progression of diabetes; | |||
b) the prevention of cardiovascular disease by physical activity; and | |||
c) the treatments to reduce cardiovascular risk. | |||
With regarding the first treatment – the prevention of the progression of diabetes, clinical studies have demonstrated that effective lifestyle intervention strategies and drug treatments can prevent or at least delay the progression to type 2 diabetes in high-risk individuals. For instance, the Finnish Diabetes Prevention Study found that a 5% reduction in bodyweight, achieved through an intensive diet and exercise program was associated with a 58% reduction in the risk of developing type 2 diabetes in overweight subjects with impaired glucose tolerance;<cite>21</cite> and the US Diabetes Prevention Program found that lifestyle modification reduced the incidence of type 2 diabetes by 58% in overweight adults with impaired glucose tolerance.<cite>22</cite> | |||
As the second treatment, the prevention of cardiovascular disease by physical activity, The International Diabetes Federation (''European Region'') have recommended physical activity for the prevention of cardiovascular disease complications among diabetic patients,<cite>23</cite> since studies found that physical activity was associated with reduced risk of cardiovascular disease, cardiovascular death, and total mortality in men with type 2 diabetes. People physically active at their work had a 40% lower cardiovascular mortality compared with people with lower physical activity at work. A high level of leisure-time physical activity like walking and walking pace was associated with a 33% drop in cardiovascular mortality, and moderate physical activity was linked to a 17% drop in cardiovascular mortality compared with the most sedentary group.<cite>24</cite> | As the second treatment, the prevention of cardiovascular disease by physical activity, The International Diabetes Federation (''European Region'') have recommended physical activity for the prevention of cardiovascular disease complications among diabetic patients,<cite>23</cite> since studies found that physical activity was associated with reduced risk of cardiovascular disease, cardiovascular death, and total mortality in men with type 2 diabetes. People physically active at their work had a 40% lower cardiovascular mortality compared with people with lower physical activity at work. A high level of leisure-time physical activity like walking and walking pace was associated with a 33% drop in cardiovascular mortality, and moderate physical activity was linked to a 17% drop in cardiovascular mortality compared with the most sedentary group.<cite>24</cite> | ||
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===Treatments and outcomes=== | ===Treatments and outcomes=== | ||
The preventive modalities include doctors counsel exercise, the “diabetes with CAD meal plan” aiming at long-term weight loss, aspirin in doses of 75 to 81 mg/d,<cite>37</cite> (in patients who do not tolerate or have a contra-indication to aspirin, clopidogrel can be used as an alternative antiplatelet agent <cite>38</cite>), antihypertensive therapy and glycemic control. | The preventive modalities include doctors counsel exercise, the “diabetes with CAD meal plan” aiming at long-term weight loss, aspirin in doses of 75 to 81 mg/d,<cite>37</cite> (in patients who do not tolerate or have a contra-indication to aspirin, clopidogrel can be used as an alternative antiplatelet agent <cite>38</cite>), antihypertensive therapy and glycemic control. | ||
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===Introduction=== | ===Introduction=== | ||
[[Image:Heartfailure.jpg|thumb|right|300px|The major signs and symptoms of heart failure.]] | |||
Prevalence of diabetes and heart failure are increasing exponentially worldwide <cite>40</cite>. Diabetes is well-known to increase the risk of heart failure independent of other traditional risk factors and ischemia. Most heart failure in people with diabetes results from coronary artery disease, and diabetic cardiomyopathy is only said to exist if there is no coronary artery disease to explain the heart muscle disorder.<cite>41</cite> Little is known about the prevalence of the combination of diabetes and heart failure. The most recent and extensive data on the prevalence of diabetes and heart failure are from the Reykjavi´k Study, showing that the prevalence of the combination of heart failure and diabetes is 0.5% in men and 0.4% in women, increasing with increasing age. Heart failure was found in 12% of those with diabetes compared with only 3% in individuals without diabetes.<cite>42</cite> Thus, there was a strong association between diabetes and heart failure. In the Framingham study, the incidence of heart failure was double among males and five times higher in females with diabetes during 18 years of follow-up, compared with patients free from diabetes, | Prevalence of diabetes and heart failure are increasing exponentially worldwide <cite>40</cite>. Diabetes is well-known to increase the risk of heart failure independent of other traditional risk factors and ischemia. Most heart failure in people with diabetes results from coronary artery disease, and diabetic cardiomyopathy is only said to exist if there is no coronary artery disease to explain the heart muscle disorder.<cite>41</cite> Little is known about the prevalence of the combination of diabetes and heart failure. The most recent and extensive data on the prevalence of diabetes and heart failure are from the Reykjavi´k Study, showing that the prevalence of the combination of heart failure and diabetes is 0.5% in men and 0.4% in women, increasing with increasing age. Heart failure was found in 12% of those with diabetes compared with only 3% in individuals without diabetes.<cite>42</cite> Thus, there was a strong association between diabetes and heart failure. In the Framingham study, the incidence of heart failure was double among males and five times higher in females with diabetes during 18 years of follow-up, compared with patients free from diabetes, | ||
Several clinical and experimental studies have shown that diabetes mellitus leads to functional, biochemical, and morphological abnormalities of the heart, independent of promoting myocardial ischemia, and some of these changes happen earlier in the natural history of diabetes.<cite>40</cite> Diabetes is an independent risk factor for heart failure, and promotes myocardial remodeling (a precursor of heart failure), and the mechanisms beyond ischemia that lead to the development of heart failure in individuals with varying degrees of impaired glucose homeostasis. The most common abnormality observed in asymptomatic diabetics is left ventricular diastolic dysfunction, likely resulting from greater left ventricular myocardial and vascular stiffness. There is also growing evidence that some, if not all, of these structural and biochemical myocardial abnormalities start at the pre-diabetic stage. | Several clinical and experimental studies have shown that diabetes mellitus leads to functional, biochemical, and morphological abnormalities of the heart, independent of promoting myocardial ischemia, and some of these changes happen earlier in the natural history of diabetes.<cite>40</cite> Diabetes is an independent risk factor for heart failure, and promotes myocardial remodeling (a precursor of heart failure), and the mechanisms beyond ischemia that lead to the development of heart failure in individuals with varying degrees of impaired glucose homeostasis. The most common abnormality observed in asymptomatic diabetics is left ventricular diastolic dysfunction, likely resulting from greater left ventricular myocardial and vascular stiffness. There is also growing evidence that some, if not all, of these structural and biochemical myocardial abnormalities start at the pre-diabetic stage. | ||
===Evaluation=== | ===Evaluation=== | ||