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Global Management of Type 2 Diabetes Mellitus For The Prevention of Cardiovascular Disease
Global Management of Type 2 Diabetes Mellitus For The Prevention of Cardiovascular Disease
Treatment of hypertension
Hypertension adversely affect both microvascular and macrovascular risk and has
been estimated to account for between 35% and 40% of the incrementle cardiovascular
risk associated with diabetes. Frequent modest-intensity aerobic exercise, alcohol and
sodium moderation, and weight reduction or markedly contribute improve blood
pressure. A number of randomized trial have proven the efficacy of several classes of anti
hypertensive medication, including angiotensin converted (ACE) inhibitor, angiotensin
reseptor blocker (ARB), calcium channel blocker, thiazide diuretic and beta blocker.1,5
Targets for patient with diabetes of < 130/80 mmHg have been endorsed by a
number of professional guidelines. ACE-Inhibitor should be considered first line therapy
(ARB for those in tolerance ACE inhibitor), independent of blood pressure, for all
diabetic patient aged> 55 years with additional cardiac risk factor or younger if
prevalence CVD is present, especially in the context of their incremental benefit on renal
outcomes.5
Treatment of dyslipidemia
This a common among patient in type 2diabetes, most commonly manifested as
characteristic pattern consisting of elevated triglyceride level, decrease HDL level, and
only modest elevation of LDL. Several pharmacologic agent are especially effective at
modifying this spectrum of abnormality, including niacin, and fibric acid derivated but
the CVD clinical effect remain uncertain. In contrast the statin drug, have a robust CVD
clinically outcome and are the primary drug advocated for use in patient with diabetes. 1,6
The recommended LDL therapeutic targets are as follows: LDL < 100 mg/dl in
the absent underlying CVD; LDL < 70 md/dl in the setting of prevalence CVD; and, at
maximal tolerated statin dose, at least 30% to 40% reduction from base line LDL
consentration. For the treatment of patient who have persistently elevated triglyscerid
level (>200 mg/dl) after achieving therapeutic LDL target consensus opinion advocated
that the principle secondary lipid target should be non HDL, with target level 30 mg/dl
higher than the individual patients;for responding LDL target.6
Antiplatelet therapies
Insulin resistance in type 2 diabetes are associated with myriad abnormalities in
platelet structure, life spent, activation, aggregation, yielding a prothrombotic state. The
evidence basis for the use of aspirin to reduce CVD risk in the setting of prevalence CVD
is well established, were as the role of aspirin for primary CVD risk prevention is much
less well defined. The routine use of aspirin at doses ranging from 75 to 162 mg daily
remains widely recommended for contemporary guideline for primary CVD risk
prevention for most adult patient with diabetes, including those age > 40 years or younger
with additional CVD risk factors.7
References:
1. Wild S, Roglic G, Green A, et al: Global prevalence of diabetes: estimates fot the year
2000 and projections for 2030. Diabetes Care 27:1047, 2004.
2. American Diabetes Association: Diagnosis and Classification of Diabetes Mellitus.
Diabetes Care 32:S62, 2009.
3. World Health Organization: Diabetes, fact sheet N 312, 2008.
4. Preis SR, Hwang SJ, Coady S, et a;: Trends in all-cause and cardiovascular disease
mortality among women and men with and without diabetes mellitus in Framingham
Heart Study, 1950 to 2005. Circulation 199: 1728, 2009.
5. Turnbull F, Neal B, Algert C, et al: Effects of different blood pressure lowering regimens
on major cardiovascular events in individuals with and without diabetes mellitus. Arch
Intern Med 165:1410, 2005
6. Adiels M, Olofsson SO, Taskinen MR, et al: Diabetic dyslipidemia. Curr Opin Lipidol
12: 238, 2006.
7. Baigent C, Blackwell L, Collins R, et al: Aspirin in the primary and secondary prevention
of cardiovascular disease: collaborative meta-analysis of individual participant data from
randomized trial. Lancet 373: 1849, 2009.