Treatment Of Cardiovascular Disease Risk Factors Research Articles

The interplay of cardiovascular risk factors in the metabolic syndrome and type 2 diabetes

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in the western world, and patients with diabetes have a 2- to 3-fold greater risk of CVD death than those without. This suggests an interaction between diabetes and other CVD risk factors such as hypertension and dyslipidaemia. The treatment of CVD risk factors in patients with diabetes reduces the incidence of CVD death but macrovascular damage is present in patients prior to the onset of overt diabetes, so the early identification and treatment of patients at risk of diabetes is essential for the primary prevention of CVD. Risk factors for diabetes and CVD are more likely to occur simultaneously than would be expected by chance, and this cluster of disorders is collectively called the metabolic syndrome. Individuals with the metabolic syndrome have an increased risk of CVD prior to the development of impaired glucose tolerance and diabetes, and patients with both the metabolic syndrome and diabetes are at greater risk of coronary heart disease death than patients with either diabetes or the metabolic syndrome alone. Although reducing glucose levels significantly reduces the risk of microvascular disease in patients with diabetes and/or the metabolic syndrome, it is not sufficient to significantly reduce the incidence of macrovascular disease. Additional risk factors, including hypertension and dyslipidaemia, must also be targeted in patients with these disorders.

Trends in Cardiovascular Complications of Diabetes

Despite reductions in cardiovascular disease (CVD) mortality over the past few decades, it is unclear whether adults with and without diabetes have experienced similar declines in CVD risk. To determine whether adults with and without diabetes experienced similar declines in incident CVD in 1950-1995. Participants aged 45-64 years from the Framingham Heart Study original and offspring cohorts who attended examinations in 1950-1966 ("earlier" time period; 4118 participants, 113 with diabetes) and 1977-1995 ("later" time period; 4063 participants, 317 with diabetes). Incidence rates of CVD among those with and without diabetes were compared between the earlier and later periods. Myocardial infarction, coronary heart disease death, and stroke. Among participants with diabetes, the age- and sex-adjusted CVD incidence rate was 286.4 per 10,000 person-years in the earlier period and 146.9 per 10,000 in the later period, a 49.3% (95% confidence interval [CI], 16.7%-69.4%) decline. Among participants without diabetes, the age- and sex-adjusted incidence rate was 84.6 per 10,000 person-years in the earlier period and 54.3 per 10,000 person-years in the later period, a 35.4% (95% CI, 25.3%-45.4%) decline. Hazard ratios for diabetes as a predictor of incident CVD were not different in the earlier vs later periods. We report a 50% reduction in the rate of incident CVD events among adults with diabetes, although the absolute risk of CVD is 2-fold greater than among persons without diabetes. Adults with and without diabetes have benefited similarly during the decline in CVD rates over the last several decades. More aggressive treatment of CVD risk factors and further research on diabetes-specific factors contributing to CVD risk are needed to further reduce the high absolute risk of CVD still experienced by persons with diabetes.