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298 Cardio Diabetes Medicine 2017

Table 1 9% in all-cause mortality (p = 0.02) and of 21% in in-
cidence of major vascular events (p < 0.0001) per
Traditional Nontraditonal each mmol/l of reduction in LDL-c. Besides that there
Dysplidemia Insulin resistance and Hyper- are also significant reductions in acute myocardial in-
insulinemia farction (AMI) (p < 0.0001), coronary revascularization
Hypertension Postprandial Hyperglycemia (p < 0.0001) and stroke (p < 0.0002). (6) (7) Thus the
evidence supporting the role of statins in risk reduc-
Obesity Glucose Varibility
tion is strong and various guidelines advocate the
Abdonimal Obesity Microalbuminuria initiation of statins in patients with diabetes based
Physical Exercise Haeatological Factors on cardiovascular risk.
Cigarette Smoking Thrombogenic Factors
Inflammation C-reactive pro- Proteinuria
tein Microalbuminuria, one of the earliest markers of di-
abetic nephropathy, has been shown to be associ-
Homocyste and vitamins
ated with a greater risk for cardiovascular disease
Erectivel dysfunciton and death. The HOPE ( Heart outcomes Prevention
Genetics and Epigenetics Evaluation) trial and the LIFE study showed that the
risk of an adverse cardiovascular event increased
Role of select risk factors: progressively with increased absolute levels of micro-
Glycemic control: The role of glycemic control in mi- albuminuria. Annual cardiovascular death rates also
crovascular complications of diabetes mellitus has increase with worsening diabetic nephropathy. (7)
been demonstrated in large prospective trials in (8)The existence of microalbuminura in people with
both type 1 and type 2 diabetes mellitus. However T2DM is an important early sign that should alert us
the same has not been conclusive for macrovascu- to the onset of a systemic endothelial disease, and
lar complications. A meta-analysis of 13 prospective associated target organ damage to the heart, the
studies showed the relative risk for any cardiovascu- brain and the kidney.
lar event was 1.18 (CI 1.10-1.26) for every percentage Smoking: Active smoking is associated with a high
point increase in hba1c. (5) However multiple ran- risk of total mortality and cardiovascular events
domised controlled trials conducted till date in type among patients with diabetes, while smoking cessa-
2 diabetes mellitus (ACCORD, ADVANCE, Veteran tion is associated with a reduced risk in total mor-
affairs study) have not shown benefit of glycemic tality and cardiovascular events in patients with di-
control in cardiovascular end points. abetes. Benefit of smoking cessation is more when

Systemic Hypertension: In both type 1 and 2 diabetes, stopped early.
hypertension is a major risk factor for cardiovascu- Physical activity : Multiple observational studies have
lar events and microvascular complications. A me- shown the beneficial effects of physical activity on
ta-analysis of forty studies, including 100,354 adults diabetes and related cardiovascular disease. The
with type 2 diabetes mellitus, observed that for each findings of MRFIT study provide evidence for better
10-mmHg lowering in systolic blood pressure there glycemic control and cardiovascular outcomes with
was a significant lowering in risk for many outcomes exercise. Current recommendations are to advise
such as: mortality (RR: 0.87; 95% CI 0.78–0.96); car- atleast 150 minutes of moderate intensity or 75 min-
diovascular events (RR: 0.89 [95% CI 0.83–0.95], coro- utes of vigorous intensity aerobic exercise in a week.
nary heart disease (RR: 0.88 [95% CI 0.80–0.98]) and
stroke (RR, 0.73 [95% CI 0.64–0.83]). The ADA recom- 3. Therapeutic implications in diabetes and
mends a target blood pressure goal of 140 mm hg cardiovascular disease:
systolic and 90 mm Hg diastolic blood pressure. (6)
This section examines the relationship of drugs used
Dyslipidemia: Dyslipidemia, especially raised LDL- in diabetes and their effect on cardiovascular disease.
holesterol (LDL-c) is one of the most important re-
versible risk factors for cardiovascular morbidity and Thiazolidinediones-: Rosiglitazone is infamous for its
mortality. Patients with diabetes tend to have a high- association with adverse cardiovascular risk based on
er proportion of LDL particles that are smaller and a meta-analysis of trials featuring this drug, though
denser, are more susceptible to oxidation, and may the interpretations of the data have been debated
thereby increase the risk of cardiovascular events. In extensively.
diabetics, statins promote a proportional reduction of

GCDC 2017