¿Qué medida antropométrica de exceso de peso discrimina mejor el riesgo cardiovascular? / Which of the anthropometric measures to define excess weight is the best discriminator of cardiovascular risk?

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Strict control of modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus.

BACKGROUND AND OBJECTIVE: To assess the effect of a strict control of modifiable cardiovascular risk factors on coronary risk (CR) in patients with type 2 diabetes mellitus (T2DM) in clinical practice. PATIENTS AND METHOD: Longitudinal, open and observational study in 530 patients with T2DM. Fasting plasma glucose (FPG), glycated haemoglobin (HbA 1C), postprandial capillary glucose (PCG), total cholesterol, high-density lipoprotein-cholesterol, triglycerides, systolic (SBP) and diastolic (DBP) blood pressure were measured; low-density lipoprotein-cholesterol and body mass index were calculated; and 10 years CR was predicted before and after 6 months of therapy implementation. The percentage of patients who reached the targets, according to published guidelines, and the use of insulin and various cardioprotective medications were compared before and after therapy implementation. RESULTS: There was a significant decrease in mean HbA 1C, FPG, PCG, total cholesterol, triglycerides, SBP, DBP, and CR after intervention. The percentage of patients who reached the HbA 1C, FPG, PCG, total cholesterol, triglycerides, SBP, DPB, and CR targets, and the number of subjects taking insulin and cardioprotective drugs increased significantly after intervention. CONCLUSIONS: This study shows that a strict control of modifiable cardiovascular risk factors in patients with T2DM in clinical practice has a beneficial effect over predicted CR.

Control estricto de los factores de riesgo cardiovascular modificables en pacientes con diabetes mellitus tipo 2 / Strict control of modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus

Fundamento y objetivo: Valorar en la práctica clínica qué efecto tiene, en pacientes con diabetes mellitus tipo 2 (DM2), el control estricto de los factores de riesgo cardiovascular modificables sobre el riesgo coronario (RC). Pacientes y método: Se ha realizado un estudio longitudinal, abierto y observacional. En 530 pacientes con DM2 se midieron la glucosa plasmática en ayunas (GPA), hemoglobina glucosilada (HbA1C), glucosa capilar posprandial (GCP), colesterol total, colesterol unido a lipoproteínas de alta densidad, triglicéridos, presión arterial sistólica (PAS) y diastólica (PAD); además se calcularon el colesterol unido a lipoproteínas de baja densidad, el índice de masa corporal y el RC a 10 años, antes y 6 meses después de intensificar el tratamiento. Se compararon el porcentaje de pacientes que alcanzaron los objetivos, de acuerdo con las guías publicadas, y la utilización de insulina y de medicaciones cardioprotectoras antes y 6 meses después de la intervención. Resultados: Después de la intervención se observó una disminución significativa de los valores de HbA1C, GPA, GCP, colesterol total, triglicéridos, PAS, PAD y RC, así como un incremento significativo del porcentaje de pacientes que alcanzaron los objetivos de HbA1C, GPA, GCP, colesterol total, triglicéridos, PAS, PAD y RC, y del número de sujetos en tratamiento con insulina y medicamentos cardioprotectores. Conclusiones: Este estudio de práctica clínica muestra que el control estricto de los factores de riesgo cardiovascular modificables en pacientes con DM2 se traduce en efectos beneficiosos sobre el RC

Background and objective: To assess the effect of a strict control of modifiable cardiovascular risk factors on coronary risk (CR) in patients with type 2 diabetes mellitus (T2DM) in clinical practice. Patients and method: Longitudinal, open and observational study in 530 patients with T2DM. Fasting plasma glucose (FPG), glycated haemoglobin (HbA1C), postprandial capillary glucose (PCG), total cholesterol, high-density lipoprotein-cholesterol, triglycerides, systolic (SBP) and diastolic (DBP) blood pressure were measured; low-density lipoprotein-cholesterol and body mass index were calculated; and 10 years CR was predicted before and after 6 months of therapy implementation. The percentage of patients who reached the targets, according to published guidelines, and the use of insulin and various cardioprotective medications were compared before and after therapy implementation. Results: There was a significant decrease in mean HbA1C, FPG, PCG, total cholesterol, triglycerides, SBP, DBP, and CR after intervention. The percentage of patients who reached the HbA1C, FPG, PCG, total cholesterol, triglycerides, SBP, DPB, and CR targets, and the number of subjects taking insulin and cardioprotective drugs increased significantly after intervention. Conclusions: This study shows that a strict control of modifiable cardiovascular risk factors in patients with T2DM in clinical practice has a beneficial effect over predicted CR

Cardiovascular risk factors in patients with type 2 diabetes. Do we follow the guidelines?

OBJECTIVE: To assess the degree of control of modifiable cardiovascular risk factors (CRFs) in type 2 diabetic patients. STUDY DESIGN AND METHODS: Cross-sectional study in 501 patients with type 2 diabetes mellitus. The following parameters were used to define optimal control: glycated haemoglobin (HbA(1C)) <7.0%, fasting plasma glucose (FPG) <7.2 mmol/l, postprandial capillary glucose (PCG) <10.0 mmol/l, high-density lipoprotein cholesterol (HDL-C) >1.1 mmol/l, low-density lipoprotein cholesterol (LDL-C) <2.6 mmol/l, triglyceride levels (TG) <1.7 mmol/l, systolic blood pressure (SBP) <130 mmHg, diastolic blood pressure (DBP) <80 mmHg, body mass index (BMI) <25 kg/m2, waist circumference (WC) <88 cm in women and <102 cm in men, and current non-smoking status. The use of various cardioprotective medications was also evaluated. RESULTS: Mean (+/-S.D.) age was 65.4 +/- 11.9 years, 218 (44%) were male. Ninety-six (19%) met coronary artery disease (CAD). Two hundred seven patients (41%) had an HbA(1C) <7.0%, 134 (27%) a FPG <7.2 mmol/l and 231 of 353 (65%) a PCG <10.0 mmol/l. Only 206 (41%) achieved an LDL-C <2.6 mmol/l, but 370 (74%) and 308 (62%) reached an HDL-C >1.1 mmol/l and a TG levels <1.7 mmol/l, respectively. In 359 (72%) patients DBP was <80 mmHg, but in only 136 (27%) was SBP <130 mmHg. Sixty four (13%) achieved a BMI <25 kg/m2, and 420 (84%) were non-smokers. Forty three (15%) women and 104 (48%) men had a WC <88 or <102 cm, respectively. None of the patients had optimal control of all CRFs. CONCLUSIONS: These data demonstrate poor control of modifiable CRFs in the population studied, and support the need for great effort to achieve the recommended goals.