Abstract
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.
Résumé
Le diabète sucré (DS), une maladie métabolique chronique caractérisée par une hyperglycémie,
est un facteur de risque cardiovasculaire (CV) sérieux. Il aggrave les effets de tous
les autres facteurs de risque, conduit prématurément aux maladies microvasculaires
et macrovasculaires, facilite le développement de l’insuffisance cardiaque, aggrave
l’évolution clinique de toutes les maladies CV et raccourcit l’espérance de vie. Le
DS établi, le DS non diagnostiqué et la dysglycémie qui peuvent progresser vers le
DS sont généralement tous présents au moment du tableau clinique de la maladie CV
patente. Par conséquent, les spécialistes et les résidents dans le domaine des maladies
CV traitent fréquemment les patients atteints de dysglycémie. Le rôle traditionnel
et avéré des cardiologues dans la réduction du risque d’événements macrovasculaires
dans cette population passe par le traitement énergique des lipides et de la pression
artérielle. Cependant, un rôle plus proactif dans la détection et la prise en charge
du DS promet de devenir de plus en plus important alors que la prévalence continue
d’augmenter et les thérapies continuent de s’améliorer. Ces dernières comprennent
les traitements antihyperglycémiques dont les profils d’innocuité cardiovasculaire
prouvée et les propriétés de réduction des événements CV qui ne sont pas encore complètement
élucidés et nécessairement liés à la régulation de la glycémie. En conséquence, le
but de cet article est : 1) d’accroître l’intérêt des cardiologues quant aux étapes
préliminaires de l’évolution naturelle du DS, lorsque la prévention ou la détection
précoce aiderait à obtenir de plus grands avantages; 2) de mettre en lumière les principes
de la prise en charge optimale de la glycémie en insistant sur les choix supplémentaires
qui démontrent une réduction prometteuse des événements CV et l’absence d’effets CV
indésirables; 3) d’encourager les cardiologues à devenir des partenaires proactifs
dans les soins multidisciplinaires nécessaires pour assurer une santé vasculaire optimale
tout au long de la vie des patients atteints du DS ou qui sont exposés au risque d’en
être atteints.
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Article info
Publication history
Published online: July 27, 2016
Accepted:
July 13,
2016
Received:
April 20,
2016
Footnotes
See page 374 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
