[Cardiovascular prevention in diabetic patients: an evidenced-based review].

Diabetes mellitus is a condition associated with cardiac complications, especially artherothrombotic disease. Several studies have demonstrated the importance of reducing cardiovascular burden on this population by adopting prevention strategies. This article revised clinical evidences on cardiovascular risk assessment and prevention actions, taking into consideration major recommendations in the field. Life-style changes with low-carbohydrate diet, weight control, and regular physical activity must be implemented. High-risk patients or with established cardiovascular disease ought to have glycemic levels<100 mg/dL and A1c<7%. It is recommended low dose of aspirin and statin for lipid management, targeting LDL<100 mg/dL, HDL>50 mg/dL and tryglycerides<150 mg/dL. Blood pressure control with non-pharmacological and antihypertensive drugs must be instituted, favoring ACE inhibitors as first option, mainly in patients with renal disease, and combined with tiazydes for the majority to achieve target blood pressure of <130/80 mmHg.

[1]  Fernando Costa,et al.  Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus , 2007, Diabetes Care.

[2]  L. Smeeth,et al.  Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis , 2005, The Lancet.

[3]  R. Collins,et al.  Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins , 2005, The Lancet.

[4]  S. Harris,et al.  Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). , 2005, Diabetes research and clinical practice.

[5]  S. Yusuf,et al.  Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study , 2004, The Lancet.

[6]  John H Fuller,et al.  Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial , 2004, The Lancet.

[7]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[8]  D. Pella,et al.  Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial , 2002, The Lancet.

[9]  AndrewJ. S. Coats MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trial , 2002, The Lancet.

[10]  A. Mattioli,et al.  Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients , 2002, BMJ : British Medical Journal.

[11]  Nina Singh,et al.  Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence for the U.S. Preventive Services Task Force , 2002, Annals of Internal Medicine.

[12]  R. Peto,et al.  Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients , 2002, BMJ : British Medical Journal.

[13]  E. Bolson,et al.  Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. , 2001, The New England journal of medicine.

[14]  L. Kuller,et al.  Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study. , 2001, Diabetes care.

[15]  J. Pogue,et al.  Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. , 2000, The New England journal of medicine.

[16]  John S Yudkin,et al.  Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study , 2000, BMJ : British Medical Journal.

[17]  Barry R. Davis,et al.  Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. , 2000, JAMA.

[18]  C. Bulpitt,et al.  Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension , 1999 .

[19]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[20]  Joël Ménard,et al.  Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial , 1998, The Lancet.

[21]  M. Hanefeld,et al.  Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up , 1996, Diabetologia.

[22]  S. Yusuf MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary , 2002 .