Page 155 - fbkCardioDiabetes_2017

Cardio Diabetes Medicine 2017 131

Cardiovascular Risk in Diabetes:

Known v/s Unknown

Dr. T.P. Weerarathna,
MBBS, MD, FCCP, FACP, FRCP
Professor in Medicine, Faculty of Medicine
Galle, Sri Lanka

Abstract T2DM living in the developing countries especially in
Type 2 diabetes increases the risk of cardiovascular the south Asian region still have a rising morbidity
2
disease. South Asian ethnicity augments this risk and mortality from CVD . With high incidence of di-
with early onset and diffuse atherosclerotic disease abetes manifested at a relatively younger age with
especially among individuals with diabetes. more adverse risk factor profile favoring accelerated
atherosclerosis, health authorities in the South Asian
There are many known and unexplored facets in countries are facing several dilemmas in controlling
the cardiovascular diseases among South Asians CVD . Although a large body of research is being
3
with diabetes. When a patient is presented with an conducted in this field, there are many unknown
acute vascular catastrophe such as acute coronary facets in the CVD risks among patients in the de-
syndrome, screening with a more sensitive test for veloping countries.
detection of glucose abnormalities can improve clin-
ical outcome. Recognition of cardiovascular risk fac- Based on studies conducted in the local setting, this
tor profiles in groups with increased susceptibility to article addresses several issues related to CVD risks
cardiovascular disease would help initiation of more among patients presented to a diabetes center in
targeted and specific therapy before progression of Southern Sri Lanka.
the disease to adverse clinical events. Selection of In the first study, sensitivity of fasting plasma glu-
most appropriate screening tool for disease stratifi- cose (FPG) in comparison to glycosylated hemoglo-
cation in to low, moderate or high risk would enable bin (HbA1C) test in detecting previously non- diabetic
implementation of more cost effective preventive individuals presenting with acute coronary syndrome
therapeutic and lifestyle measures. Recognition of is explored. Second study describes the cardiovas-
individuals under specific therapy who has a resid- cular risk profile and their associations of newly di-
ual risk would pave the way to optimize individual agnosed patients with type 2 diabetes. In the third
measures to improve clinical outcomes. study, we attempted to find out the most appropriate
cardiovascular risk screening tool for patients with
This article summarizes findings of several cross
sectional studies carried out in a diabetes center in type 2 diabetes without clinical evidence of estab-
Southern Sri Lanka highlighting many previously un- lished cardiovascular disease. The final study ad-
explored aspects of cardiovascular risk in diabetes in dresses prevalence and associations of suboptimal
a developing country. levels of high density lipoprotein levels (HDL) among
patients with T2DM being treated with statins.
Introduction
Cardiovascular diseases (CVD) account for a sub- Are we missing a lot with diabetes
stantial morbidity and mortality in patients with type presenting with acute coronary syndrome?
2 diabetes (T2DM) . An Individual with T2DM carries In routine clinical practice among patients admitted
1
three to four fold risk of developing CVD compared to hospital, fasting plasma glucose (FPG) is carried
to a healthy individual. Although developed coun- out to screen diabetes or impaired fasting glucose
ties can boast about a significant decline in CVD (pre-diabetes). Testing of glycosylated hemoglobin
mortality among people with diabetes, patients with (HbA1c) level in previously undiagnosed diabetic pa-

Cardio Diabetes Medicine