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Cardiodiabetology: Reducing Risks to Optimize Cardiovascular Disease Outcomes

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ASPC Manual of Preventive Cardiology

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Nearly 500 million adults worldwide currently have diabetes, a number expected to increase to 700 million over the next 25 years, largely fueled by the obesity epidemic and unhealthy lifestyles. Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease, stroke, heart failure, and peripheral arterial disease, is among the most common causes of death in persons with diabetes. However, diabetes is associated with great heterogeneity in ASCVD risks, warranting the need for cardiovascular risk assessment, including global risk scoring and consideration of risk-enhancing factors and subclinical atherosclerosis. Moreover, few persons with diabetes are at recommended targets for key ASCVD risk factors including LDL-cholesterol, blood pressure, HbA1c, nonsmoking status, and body mass index. Key treatment approaches focus on lifestyle modification, weight control, avoidance of cigarette smoking, and management of lipids, blood pressure, and blood glucose. For higher-risk patients, antiplatelet therapy is included. Blood pressure medication, statins, and, most recently, icosapent ethyl, have evidence for reducing ASCVD events in persons with diabetes. Newer medications for diabetes, including SGLT2 inhibitors and GLP-1 receptor agonists, also reduce cardiovascular events independent of level of HbA1c. Both classes prevent further kidney function deterioration while the SGLT2 inhibitors also reduce heart failure hospitalizations. Most importantly, a multidisciplinary team is required to address the myriad cardiovascular and other risks in persons with diabetes.

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Authors and Affiliations

  1. Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA

    Nathan D. Wong

  2. Metabolic Institute of America, Tarzana, CA, USA

    Yehuda Handelsman

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  1. Nathan D. Wong
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  2. Yehuda Handelsman
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Correspondence to Nathan D. Wong .

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Editors and Affiliations

  1. Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA

    Nathan D. Wong

  2. Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA

    Ezra A. Amsterdam

  3. Cicarrone Center for the Prevention of Cardiovascular Disease, John Hopkins University School of Medicine, Baltimore, MD, USA

    Peter P. Toth

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Wong, N.D., Handelsman, Y. (2021). Cardiodiabetology: Reducing Risks to Optimize Cardiovascular Disease Outcomes. In: Wong, N.D., Amsterdam, E.A., Toth, P.P. (eds) ASPC Manual of Preventive Cardiology. Contemporary Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-56279-3_12

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