Featured Research

from universities, journals, and other organizations

Don’t forget to screen for diabetes in CAD patients, says European Society of Cardiology

Date:
November 13, 2012
Source:
European Society of Cardiology (ESC)
Summary:
While it is well recognized that patients with diabetes are at risk of developing Coronary Artery Disease (CAD), on World Diabetes Day, the European Society of Cardiology highlights the fact that patients with CAD are also at great risk of developing diabetes mellitus.

While it is well recognized that patients with diabetes are at risk of developing Coronary Artery Disease (CAD), on World Diabetes Day, the European Society of Cardiology (ESC) highlights the fact that patients with CAD are also at great risk of developing diabetes mellitus (DM).

"This is the reverse of what we usually think," says Professor Hans Erik Botker, an ESC spokesperson from Aarhus University Hospital, Skejby, Denmark. "And it also needs to be remembered that not only should we be checking patients who have suffered an Acute Myocardial Infarction (AMI) for diabetes, but also there is a need to check everyone diagnosed with stable Coronary Artery Disease (CAD) as they are also at increased risk." The link is that metabolic syndrome (a cluster of conditions including raised triglycerides, reduced HDL cholesterol, raised blood pressure, and raised fasting plasma glucose) poses a risk factor for developing both CAD and diabetes. "The result is that patients with CAD are at risk of developing diabetes at the same time," says Dr Christoph Saely, from the Academic Teaching Hospital in Feldkirch, Austria.

A number of studies have indicated the scale of the problem. In the Swedish Registry for Coronary Care study it was found that 21% of patients experiencing AMI were known to have diabetes (1). Furthermore the Euro Heart Survey on Diabetes and the Heart, which recruited patients from 25 countries, found that diabetes was identified in 25% of AMI patients who were not known to have diabetes when given an oral glucose tolerance test (2). Finally, a recent study undertaken by Christoph Saely (3), showed that even coronary patients who were found to be clear of diabetes were at risk of going on to develop diabetes. Saely and colleagues, prospectively tracked 506 non-diabetic patients who had undergone coronary angiography for the evaluation of stable CAD.

Over 7.5 years of follow-up, the investigators found that 106 new cases of diabetes emerged (21.1%), which corresponds to a rate of 2.9% per year. The study also showed that for the 293 patients diagnosed with severe CAD, 26.4% went on to develop diabetes compared with 16.4% among those with less extensive disease.

When the research team scrutinized the various metabolic risk factors, they observed that besides fasting glucose, low HDL cholesterol, elevated triglycerides, and a large waist circumference were strong predictors of the development of diabetes among coronary patients.

Professor Lena Jonasson, an ESC spokesperson from Linkφping University, Sweden, comments, "This study underlines the need for good infrastructures to be put in place that allow all patients with CAD to be screened not only for diabetes at diagnosis, but to be followed on a regular basis."

Such thinking is clearly in line with the ESC Clinical Practice Guidelines "Diabetes, Pre-Diabetes and Cardiovascular Diseases" (http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/diabetes.aspx), published in 2007, which recommended that every patient admitted to hospital for AMI should be screened for diabetes, and that all patients with a diagnosis of CAD should be followed up for diabetes on a regular basis. While the 2007 ESC Clinical Practice Guidelines recommended oral glucose tolerance tests, the current consensus recommendations from the European Association for the Study of Diabetes, American Diabetes Association, International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation recommend the haemoglobin A1C assay test. "This is an altogether easier approach because you just need to take a blood sample," says Botker.

But there can be issues around whether patients with CAD are followed up by cardiologists in hospitals or family doctors. "The reality is that cardiologists only follow patients carefully for a very short period and then refer them back to GPs. Whether they have further tests for diabetes depends on the individual interests of family doctors placing patients at risk of falling through the net," says Jonasson.

Identifying patients who have both CAD and diabetes is essential because they need to be treated more aggressively with both drugs and life style interventions. "When patients have both diabetes and CAD the problem is that risk factors aren't just simple additives, they multiply each other putting patients at greater risk of a worse outcome for both conditions," says Professor Keith Fox, a cardiologist from the University of Edinburgh and chair of the ESC Congress Programme Committee.

From the perspective of drug therapies patients with both diabetes and CAD benefit from potent statins (like atorvastatin) irrespective of their baseline cholesterol levels, antiplatelet therapy with aspirin, blood pressure control with ACE inhibitors and ARBs (these agents have been shown to have a favourable influence on progression of diabetic nephropathy), and glucose lowering therapy.

Patients can also benefit from lifestyle interventions such as weight management, changing their diets (including plenty of fruits, vegetables, and whole grains) and increasing physical activity. "Above all Increasing levels of exercise may be the most effective approach because it can reduce the low-grade systemic inflammation that's associated with both CAD and diabetes," says Jonasson.

So convinced are Jonasson and her Swedish colleagues of the benefits of exercise for patients with both CAD and diabetes, that they prescribe sessions in the local gym. "We give them different doses of exercise specifying the intensity and the type of exercise. Providing such clear directions helps compliance."

The spotlight of the next ESC Congress 2013 in Amsterdam, The Netherlands, 31 August to 4 September, will be how the heart interacts with other organs. "The heart should not be considered in isolation, and so we'll be looking at how heart disease interacts not only with diabetes, but also with other organs systems such as the kidneys, brain, lungs, and the immune and haemopoietic systems," says Professor Fox.

World Diabetes Day: http://www.idf.org/worlddiabetesday/

References

(1) Eur Heart Journal 2003; 24:838-844

(2) Eur Heart Journal 2004;25:1880-1890

(3) Dr Christoph Saely works in the team of Heinz Drexel at the VIVIT Institute in Feldkirch, Austria, reported at the European Association for the Study of Diabetes meeting in October 2012 C Saely, A Vonbank, P Rein, et al. Coronary artery disease as a risk for developing type 2 diabetes mellitus. Abstract no. 339.Presented at 48th Annual Meeting of the European Association for the Study of Diabetes. 1-5 October 2012. Berlin, Germany.


Story Source:

The above story is based on materials provided by European Society of Cardiology (ESC). Note: Materials may be edited for content and length.


Cite This Page:

European Society of Cardiology (ESC). "Don’t forget to screen for diabetes in CAD patients, says European Society of Cardiology." ScienceDaily. ScienceDaily, 13 November 2012. <www.sciencedaily.com/releases/2012/11/121113214643.htm>.
European Society of Cardiology (ESC). (2012, November 13). Don’t forget to screen for diabetes in CAD patients, says European Society of Cardiology. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2012/11/121113214643.htm
European Society of Cardiology (ESC). "Don’t forget to screen for diabetes in CAD patients, says European Society of Cardiology." ScienceDaily. www.sciencedaily.com/releases/2012/11/121113214643.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) — Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) — Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) — At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Xtreme Eating: Your Daily Caloric Intake All On One Plate

Xtreme Eating: Your Daily Caloric Intake All On One Plate

Newsy (July 30, 2014) — The Center for Science in the Public Interest released its 2014 list of single meals with whopping calorie counts. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:  

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile iPhone Android Web
      Follow Facebook Twitter Google+
      Subscribe RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins