Diabetes for Cardiologists: Practical Issues in Diagnosis and Management.
Diabetes mellitus (DM), a chronic metabolic disease characterized by hyperglycemia, is a profound cardiovascular (CV) risk factor. It compounds the effects of all other risk factors, leads to premature micro- and macrovascular disease, facilitates development of heart failure, worsens the clinical course of all CV diseases, and shortens life expectancy. Established DM, unrecognized DM, and dysglycemia that may progress to DM are all commonly present at the time of presentation of overt CV disease. Thus, CV specialists and trainees frequently treat patients with dysglycemia. The traditional and proven role of cardiologists in reducing the risk of macrovascular events in this population is through aggressive lipid and blood pressure treatment. However, a more proactive role in the detection and management of DM is likely to become increasingly important as the prevalence continues to increase and therapies continue to improve. The latter include antihyperglycemic therapies with proven cardiovascular safety profiles and CV event reduction properties not yet fully elucidated and not necessarily related to glycemic control. Accordingly, the purpose of this article is to (1) expand the interest of cardiologists in earlier stages of the natural history of DM, when prevention or early detection might help achieve greatest benefit; (2) highlight principles of optimal glycemic management, with an emphasis on add-on choices showing promising reduction of CV events and lacking CV adverse effects; and (3) encourage cardiologists to become proactive partners in the multidisciplinary care needed to ensure optimal lifelong vascular health in patients with, or who are at risk of, DM.
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
G B John
GB
Mancini
Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada.
Alice Y
AY
Cheng
Division of Cardiology, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, University of Toronto, Ontario, Canada.
Kim
K
Connelly
Division of Cardiology, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, University of Toronto, Ontario, Canada.
David
D
Fitchett
Endocrinology and Metabolism, North York General Hospital and LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
Ronald
R
Goldenberg
Division of Cardiology, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, University of Toronto, Ontario, Canada.
Shaun G
SG
Goodman
Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, University of Toronto, Ontario, Canada.
Lawrence A
LA
Leiter
Population Health Research Institute and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Eva
E
Lonn
Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada.
Breay
B
Paty
Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Paul
P
Poirier
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
James
J
Stone
Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada.
David
D
Thompson
Division of Endocrinology, McGill University Health Centre, McGill University, Montreal, Québec, Canada.
Jean-François
JF
Yale
D000072096:Cardiologists; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*
D007004:Hypoglycemic Agents; D008055:Lipids