[Diabetes mellitus and cardiovascular risk. Is integrated therapy of type 2 diabetes and cardiovascular risk factors necessary?]. / La diabetes mellitus y el riesgo cardiovascular. ¿Es necesario el tratamiento integral de la diabetes mellitus tipo 2 y los factores de riesgo cardiovascular?

Cardiovascular disease (CVD) is the first cause of death in the Spanish population among both diabetics and non-diabetics. In diabetes, CVD is between 2 and 4 times more frequent, earlier and more aggressive. With current measures, approximately 50% of CVD can be prevented. The risk factors for CVD in diabetes are hypertension, dyslipidemia, smoking, obesity and sedentariness. More than 80% of patient with type 2 diabetes have hypertension and dyslipidemia and approximately 15% continue to smoke. However, all these factors are controlled in at least 10%. Although dyslipidemia is the most influential and least treated factor, the greatest benefit for CVD prevention is obtained with integrated intervention on all risk factors, reducing blood pressure to below 140/80 mmHg, low-density lipoprotein cholesterol (LDL-c) to below 100 mg/dl, encouraging smoking cessation, regular physical activity and maintaining a healthy weight (BMI < 25 kg/m²). In secondary prevention or persons with microvascular disease, the targets may be stricter (blood pressure 130/80 mmHg and LDL-c 80 mg/dl). Drug treatment should always include an angiotensin converting-enzyme inhibitor or an angiotensin II receptor antagonist and a statin. Aspirin should be reserved for patients in secondary prevention or with very high CV risk. Consequently, interventions should be prioritized according to the foreseeable risk for each patient, which can be estimated through the SCORE scale or other scales such as Regicor or UKPDS, with a SCORE > 5% indicating high risk. These high-risk patients should receive personalized care.

Liraglutide in the treatment of Type 2 diabetes: clinical data and practical considerations for its use.

Liraglutide is the first once-daily human glucagon-like peptide-1 analog available for use in clinical practice. It has recently been approved by the EMA and the US FDA for treatment of Type 2 diabetes mellitus (T2DM). Initial approval is for use in combination with either metformin or a sulfonylurea, or in combination with metformin plus a sulfonylurea or thiazolidinedione. Liraglutide monotherapy is approved in the USA. Results from the Liraglutide Effect and Action in Diabetes (LEAD) clinical trials program indicate that liraglutide significantly lowers glycosylated hemoglobin (HbA1c) with a low risk of hypoglycemia. Liraglutide is also associated with significant and sustained weight loss, decreased systolic blood pressure, and improvements in other markers of cardiovascular risk. Liraglutide also shows strong potential to preserve ß-cell function. Maximum benefits may be achieved when liraglutide treatment is initiated early on in the course of T2DM.