Disease

Prakash C. Deedwania, MD, FACC, FACP, FCCP, FAHA

Guest Editor

Prakash C. Deedwania, MD, FACC, FACP, FCCP, FAHA

Guest Editor

Cardiovascular (CV) complications are the leading cause of death and disability in patients with type II diabetes mellitus. As described in the November 2004 issue of the Cariology Clinics, it is important to recognize that vascular abnormalities and dysfunction begin in the prediabetic phase, which often precedes development of clinical signs and symptoms of diabetes by an average of 5 to 6 years.

Although due emphasis has been placed on tight control ofblood glucose in diabetic patients during the past two decades, the management of other frequently associated coronary risk factors has not received as much attention. A large number of randomized clinical trials have now shown that aggressive management of most associated risk factors—in particular hypertension and hyperlip-idemia in diabetic patients—is associated with significant reduction of the risk of future CV events. As a matter of fact, beginning with the findings from the United Kingdom Prospective Diabetes studies, many of the trials have demonstrated that tight control of blood pressure is more beneficial in reducing the rate of CV complications in diabetic patients. Similar results are beginning to emerge from the trials with statins in patients with diabetes. Although more work is needed, there is emerging evidence that for maximum CV protection comprehensive risk reduction approach is necessary and feasible. It is also important to realize that because of the overall increased absolute risk of CV events, diabetic patients tend to benefit more with most of the effective risk factor interventions. Based on the results of these studies, various guideline committees have set aggressive goals for therapy in diabetic patients. However, despite the available evidence and guideline recommendations, most diabetic patients are not at goal blood pressure, target lipid levels, or good long-term glycemic control. Serious medical attention and concerted clinical efforts are needed to achieve adequate control of all risk factors in diabetic patients to provide maximum CV protection. It is also important to realize that such interventions are not only good for these patients, they are cost-effective as well.

It was with the above points in mind and the obvious need to examine the benefits of various treatment options in diabetic patients that this issue of the Cardiology Clinics was conceived. Its primary goal is to present state-of-the-art articles that examine and summarize the most relevant literature dealing with treatment of various components that are associated with increased risk of CV complications in diabetes. The authors represent an outstanding group of internationally recognized authorities in their field.

The first article examines the role of intensive glycemic control during the acute phase of acute myocardial infarction in diabetic patients. This is followed by an article describing and comparing the role of traditional oral hypoglycemic drugs such as insulin secretagogues and the newer insulin-sensitizing agents in preventing CV complications of diabetes. The next article deals with the common problem of the deadly duet of diabetes and hypertension and describes the totality of evidence demonstrating the benefits of aggressive blood pressure reduction in reducing the rate of coronary events, congestive heart failure, strokes, and renal complications in patients with diabetes.

It is now well recognized that many diabetic patients have atherogenic dyslipidemia. A number of recent clinical trials have also documented the benefits of lipid-lowering therapies in diabetic patients. The article by Ganda provides a critical appraisal regarding various issues dealing with lipid abnormalities and management considerations in diabetes. The best approach for prevention of CV complications in diabetes would be prevention of diabetes itself, and it is with this point in mind that the next article in the issue describes the preventive strategies with special emphasis on the emerging evidence suggesting potential benefits of renal-angiotensin system blockade in the prevention of diabetes and the related CV complications.

Ever since the results of the bypass angioplasty revascularization investigation trial became available there has been considerable controversy regarding the most appropriate revasculariza-tion strategy in diabetic patients. The article by Mukherjee provides a comprehensive review regarding the role of percutaneous coronary intervention versus coronary artery bypass graft surgery in diabetes. Finally, as stated earlier, there is emerging evidence that to achieve the maximum benefits of therapeutic strategy, a comprehensive risk reduction approach that incorporates aggressive risk factor modification is necessary. The article by Srikant and Deedwania provides a critical appraisal and clinically meaningful ideas to incorporate an integrated approach for comprehensive CV risk reduction in diabetes. The last article in the issue provides the rationale and summary of various clinical trials examining a variety of therapeutic approaches for the prevention of CV complications in diabetes.

It is my hope that the compendium of articles in this issue spanning from established therapies to emerging treatments and therapeutic approaches in the future will help clinicians achieve the goal of providing maximum CV protection to patients with diabetes.

I would like to thank Michael Crawford, MD, the Consulting Editor of the Cardiology Clinics, for inviting me to compile this second issue dealing with diabetes and CV disease. I would especially like to express my gratitude to all of the contributors and collaborators for providing their input and articles in a timely manner. Finally, I would like to thank my family and friends, who are always so supportive of my academic endeavors.

Prakash C. Deedwania, MD, FACC, FACP, FCCP, FAHA

Veterans Administration Central California Health Care System University of California-San Francisco at Fresno 2615 E. Clinton Avenue Fresno, CA 93703, USA

E-mail address: [email protected]

ELSEVIER SAUNDERS

Cardiol Clin 23 (2005) 109-117

CARDIOLOGY CLINICS

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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