Diabetes is among the most common chronic disease in the world affecting an estimated 285 million adults in 2010 (6.4% of the global adult population). Estimates project that diabetes will affect more than 430 million persons (7.7% of global adult population) by 2030. Among all complications of diabetes CVD (Cardiovascular disease) remains the principal co morbid condition.

Atherosclerosis : Compared with non  diabetic person patients with diabetes have a 2 to 4 fold increased risk for development and death from CHD. Across the spectrum of ACS (Acute Coronary Syndrome) events in which diabetes may affect more than 1 in 3 patients, those with diabetes have worse CVD outcome after ACS events.

In addition to  CHD (Coronary heart disease) Diabetes increase the risk of stroke  and of cardiovascular and peripheral artery disease. Diabetes portends 2 fold increased stroke risk and 2-6 fold increased risk for adverse clinical outcome after stroke.

Similarly among patients with symptomatic peripheral artery disease, diabetes prevalence ranges from 20 to 30% and accounts for approx 50% of all lower limb amputations.

Heart failure: In ambulatory setting, diabetes is independently associated with 2-5 fold increased risk of heart failure over that in persons without diabetes and patients with diabetes have worse outcome once heart failure develops.

Prevention of CHD in setting of DM

Therapeutic life style intervention: It remains the corner stone of prevention of atherosclerotic complications associated with diabetes. ADA (American Heart Association) and AHA (American Diabetes Association) recommend over arching therapeutic lifestyle targets including smoking abstinence, at least 150 minute of moderate intensity aerobic activity weekly or 90 minutes vigorous exercise per week, and nutrition recommendations for weight control .

Medical nutrition therapy: It should be targeted at caloric restriction for weight management with limited fat intake < 30% of dietary energy, <7% from saturated fats and increased dietary fibers. Dietary cholesterol should be <200 mg/day, trans-fat intake should be <1% of energy intake.

Blood Pressure : Patients with diabetes should be treated to lower systolic BP at least <140 mm Hg and diastolic BP <90 mm Hg by dietary control , increased activity , alcohol moderation, sodium reduction, increased consumption of fresh fruit and vegetables in addition to medication.

Cholesterol: In adult patients, lipid levels should be measured  at least annually and in younger adults < 40 years with low risk lipids values (LDLC <100, HDLC>50, TG<150) assessment should be repeated every two years.

Beyond life style , pharmacological strategies effectively reduce CVD risk in diabetes, such interventions include BP and cholesterol management for all patients. And in high risk patients, ACE inhibitors independent of BP and also daily aspirin is advised.

Glucose control : In general HbA1c target of below 7% is recommended for all patients with Diabetes. A more personalized approach recommend for appropriate HbA1c targets based on patient and drug characteristics.

Role of Society 

In spite of so many advances and research work on Diabetes and Heart disease, the gradient of risk associated with diabetes persists. It is because, studies consistently demonstrating a gap between accumulated evidence and its application in patients with diabetes in the community.  So a continued effort  required by medical service provider and the society to educate the people for optimal application of existing evidence for CVD risk reduction.

Dr RusheeKanta Mohanta, MD DM

Consultant Interventional Cardiology

Heartmate Institute