Abstract
A 54-year-old man presents at the Institute of Sports Medicine, Prevention and Rehabilitation for an assessment of his physical fitness. His wife gave him a voucher for a physical fitness check as a birthday present since he has never had an assessment of his physical fitness before. He is a carpenter and reports to be healthy and free of symptoms. Two years ago, he had a non-ST-elevation myocardial infarction of the anterior wall. The left descending artery had been treated with a drug-eluting stent in the local cardiology department. On presentation, he reports no angina or other cardiac disorders. The patient smokes one pack of cigarettes per day (30 pack years). Both of his parents are still alive, his father is 76 years old and suffers from type 2 diabetes and chronic obstructive pulmonary disease, whereas his 75-year-old mother has no known disorders. Neither his two brothers nor his sister has any cardiovascular diseases, and his two sons who are 27 and 30 years old are also healthy. He reports 30–45 min of jogging once a week, and his present medication includes 100 mg of acetylsalicylic acid, a beta-blocker (metoprolol 50 mg 1/2-0-0), an angiotensin-converting enzyme (ACE) inhibitor (ramipril 2.5 mg 1-0-0), and a statin (simvastatin 40 mg 0-0-1). How is this patient best advised to improve his cardiovascular risk profile?
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetiere P, Jousilahti P, Keil U, Njolstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM, group Sp. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987–1003.
Authors/Task Force M, Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL, Guidelines ESCCfP, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schachinger V, Scheen A, Schirmer H, Stromberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–87. doi:10.1093/eurheartj/eht108.
Drechsler K, Fikenzer S, Sechtem U, Blank E, Breithardt G, Zeymer U, Niebauer J. The Euro Heart Survey – Germany: diabetes mellitus remains unrecognized in patients with coronary artery disease. Clin Res Cardiol Off J German Cardiac Soc. 2008;97(6):364–70. doi:10.1007/s00392-008-0643-z.
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Guidelines ESCCfP. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847. doi:10.1093/eurheartj/ehs104.
Fox K, Ford I, Steg PG, Tendera M, Robertson M, Ferrari R. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet. 2008;372(9641):817–21. doi:10.1016/s0140-6736(08)61171-x.
Group TSR. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16. doi:10.1056/NEJMoa1511939.
Latimer J, Batty JA, Neely DD, Kunadian V. PCSK9 inhibitors in the prevention of cardiovascular disease. J Thromb Thrombolysis. 2016; doi:10.1007/s11239-016-1364-1.
Sixt S, Rastan A, Desch S, Sonnabend M, Schmidt A, Schuler G, Niebauer J. Exercise training but not rosiglitazone improves endothelial function in prediabetic patients with coronary disease. Eur J Cardiovasc Prev Rehabil. 2008;15(4):473–8. doi:10.1097/HJR.0b013e3283002733.
Niebauer J. Treatment after coronary artery bypass surgery remains incomplete without rehabilitation. Circulation. 2016;133(24):2529–37.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte op Reimer WJ, Vrints C, Wood D, JL Z, Zannad F. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635–701. doi:10.1093/eurheartj/ehs092.
Tschentscher M, Eichinger J, Egger A, Droese S, Schonfelder M, Niebauer J. High-intensity interval training is not superior to other forms of endurance training during cardiac rehabilitation. Eur J Prev Cardiol. 2016;23(1):14–20. doi:10.1177/2047487314560100.
Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(6):1433–8. doi:10.2337/dc06-9910.
Egger A, Niederseer D, Diem G, Finkenzeller T, Ledl-Kurkowski E, Forstner R, Pirich C, Patsch W, Weitgasser R, Niebauer J. Different types of resistance training in type 2 diabetes mellitus: effects on glycaemic control, muscle mass and strength. Eur J Prev Cardiol. 2013;20(6):1051–60. doi:10.1177/2047487312450132.
Niebauer J, Mayr K, Tschentscher M, Pokan R, Benzer W. Outpatient cardiac rehabilitation: the Austrian model. Eur J Prev Cardiol. 2013;20(3):468–79. doi:10.1177/2047487312446137.
Sixt S, Beer S, Bluher M, Korff N, Peschel T, Sonnabend M, Teupser D, Thiery J, Adams V, Schuler G, Niebauer J. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease. Eur Heart J. 2010;31(1):112–9. doi:10.1093/eurheartj/ehp398.
Niebauer J, Mayr K, Harpf H, Hofmann P, Muller E, Wonisch M, Pokan R, Benzer W. Long-term effects of outpatient cardiac rehabilitation in Austria: a nationwide registry. Wien Klin Wochenschr. 2014;126(5–6):148–55. doi:10.1007/s00508-014-0527-3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Niederseer, D., Diem, G., Niebauer, J. (2017). Diabetes Mellitus Type 2 and Cardiovascular Disease. In: Niebauer, J. (eds) Cardiac Rehabilitation Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-47738-1_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-47738-1_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-47737-4
Online ISBN: 978-3-319-47738-1
eBook Packages: MedicineMedicine (R0)