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- May 17, 2008 |
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"Evidence Versus Reality: Gaps in Cardiovascular Risk Factor Intervention for Diabetic Patients"Dr. Baiju R. Shah (biography)
English - 2005-05-06 - 27 minutes
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Summary :
In this presentation Dr. Shah presents evidence for cardiovascular (CV) risk factor intervention in diabetic patients and discusses the current state of underutilization of medications to lower CV risk.
In terms of evidence for CV risk factor intervention in diabetic patients, large randomized trials have shown the benefits of tight blood pressure control (1-3), and lipid control (4-6) in reducing the risk of coronary and cerebrovascular events. The Steno-2 study further showed the superior efficacy in terms of a composite endpoint, of intensive multifactorial interventions compared to conventional treatment in a small group of type 2 diabetic patients with microalbuminuria (7). Dr. Shah discusses current Canadian and U.S. guidelines in terms of blood pressure and cholesterol targets (8,9).
Despite the importance of good blood pressure and lipid control, these parameters are inadequately controlled in diabetic patients (10), with an underutilization of medications proven to reduce CV risk (11). Dr. Shah concludes by discussing possible causes of these gaps in diabetes care and potential solutions.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
- To examine the gap in cardiovascular risk intervention for diabetic patients between evidence and actual clinical practice;
- To understand why this gap may occur;
- To counter the glucose-focused approach to diabetes management in clinical practice.
Bibliographic references :
1. UK Prospective Diabetes Study Group.
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
BMJ 1998;317:703-13.
2. J. D. Curb, S. L. Pressel, J. A. Cutler, P. J. Savage, W. B. Applegate, H. Black, G. Camel, B. R. Davis, P. H. Frost, N. Gonzalez, G. Guthrie, A. Oberman, G. H. Rutan and J. Stamler. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group JAMA. Vol. 276 No. 23, December 18, 1996.
3. ProfLennart Hansson MD, Alberto Zanchetti MD, S George Carruthers MD, Björn Dahlöf MD, Dag Elmfeldt MD, Stevo Julius MD, Joël Ménard MD, Karl Heinz Rahn MD, Hans Wedel PhD, Sten Westerling Msc and for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial The Lancet. Volume 351, Issue 9118 , 13 June 1998, Pages 1755-1762.
4.K Pyorala, TR Pedersen, J Kjekshus, O Faergeman, AG Olsson and G Thorgeirsson. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S)Diabetes Care. 1997; Vol 20, Issue 4: 614-620.
5. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial The Lancet. Volume 361, Issue 9374 , 14 June 2003, Pages 2005-2016.
6. Prof Helen M Colhoun, MD, Prof D John Betteridge, PhD, Prof Paul N Durrington, MD, Prof Graham A Hitman, MD, H Andrew W Neil, DSc, Shona J Livingstone, MSc, Margaret J Thomason, PhD, Michael I Mackness, PhD, Valentine Charlton-Menys, PhD and Prof John H Fuller, MRCP. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial The Lancet. Volume 364, Issue 9435 , 21 August 2004, Pages 685-696.
7. Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes NEJM. Volume 348:383-393 January 30, 2003.
8. Can J Diabetes. 2003;27(suppl 2).
9. Diabetes Care. 2005;28(suppl 1).
10. Jinan B. Saaddine, MD; Michael M. Engelgau, MD; Gloria L. Beckles, MD; Edward W. Gregg, PhD; Theodore J. Thompson, MS; and K.M. Venkat Narayan, MD. A Diabetes Report Card for the United States: Quality of Care in the 1990s Ann Int Med.16 April 2002;Volume 136 Issue 8: 565-574.
11. Lauren C. Brown, Jeffrey A. Johnson, Sumit R. Majumdar, Ross T. Tsuyuki and Finlay A. McAlister. Evidence of suboptimal management of cardiovascular risk in patients with type 2 diabetes mellitus and symptomatic atherosclerosis CMAJ. November 9, 2004; 171 (10).
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