Prevention of Type 2 Diabetes: A Cardiologist's Perspective

Abstract

Based on the results of numerous clinical trials, it has been proved that type 2 diabetes is one of the main risk factors for the development of cardiovascular diseases and cardiovascular mortality. The article reviews the features of the development of cardiovascular pathology in patients with carbohydrate metabolism disorders and diabetes. Chronic hyperglycemia is not only the main manifestation of the disease, but also an important pathogenetic factor in the development of almost all of its complications - micro-, macroangiopathies and neuropathies. The prevalence of arterial hypertension among patients with diabetes mellitus is noteworthy, the frequency of which is almost twice as high as in people without diabetes. In the presence of diabetes mellitus, such risk factors for cardiovascular complications as obesity, dyslipidemia, microalbuminuria are manifested, the risk of development of macrovascular (myocardial infarction, stroke) and microvascular (nephropathy, retinopathy, etc.) complications is significantly increased.In accordance with the recommendations of the European Society of Cardiology and the European Society of Atherosclerosis (EOA / EOA) for the treatment of dyslipidemia (2016), patients with type 2 diabetes mellitus are automatically classified as high or very high cardiovascular risk and are equated to patients with confirmed atherosclerotic cardiovascular disease (coronary heart disease, stroke, transient ischemic attack, peripheral arterial disease). In accordance with these recommendations, patients with diabetes mellitus and high cardiovascular risk should be given a high-intensity statin therapy for the purpose of secondary or primary prevention of cardiovascular diseases.The results of a number of studies have shown that already at the stage of early disorders of carbohydrate metabolism (prediabetes) there are manifestations of insulin resistance, compensatory hyperinsulinemia and there is an accumulation of risk factors that contribute to the launch of the pathophysiological cascade of atherosclerosis of coronary, cerebral and peripheral vessels. Thus, prediabetes is not only an intermediate stage in the development of type 2 diabetes mellitus, but also an independent risk factor for cardiovascular diseases. Quite often, type 2 diabetes mellitus debuts directly as vascular complications - myocardial infarction, cerebral stroke. Therefore, it is recommended to identify patients with a high risk of type 2 diabetes as early as possible and actively perform the correction of hyperglycemia, dyslipidemia, arterial hypertension and other risk factors for cardiovascular diseases.