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.     

Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin. Compared with individuals without diabetes, patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension, dyslipidaemia and obesity in these patients. However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors. Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus. Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events. Many of these risk factors could be common history for both diabetes mellitus and cardiovascular disease, reinforcing the postulate that both disorders come independently from “common soil”. The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients.     

Comparison of anthropometric parameters as predictors of serum lipids in premenopausal women

No single anthropometric parameter has yet been generally accepted as being superior to others in assessing the metabolic risk associated with abdominal obesity. To compare waist circumference (WC) with waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), regarding their association with serum lipids, we studied 166 women aged 20 to 48 yr; 53 were obese [body mass index (BMI) 30-39.9 Kg/m2], 50 were overweight (BMI 25-29.9 Kg/m2) and 63 normal weight (BMI 18.5-24.9 Kg/m2). Height, body weight, waist and hip circumferences, total serum cholesterol (Ch), low (LDL) and high density lipoprotein (HDL)-Ch and triglyceride (TG) concentrations were measured. The correlation coefficients between the concentration of serum lipid fractions and each anthropometric parameter did not differ significantly for any lipid variable when WC, WHR and WHtR were compared in the 166 women. The same applied for the obese and the overweight group, whereas in normal weight women there was significant association only between WC and LDL-Ch and between WHR and Ch/HDL-Ch ratio. Stepwise regression analysis showed that the proportion of variance in serum lipids did not change significantly when WHR or WHR+WHtR were added to WC into the regression model (18%, 18% and 18% for Ch; 13%, 18% and 18% for HDL-Ch; 18%, 18% and 12% for LDL-Ch; 35%, 35% and 37% for TG, respectively). These results indicate that WC is the main parameter associated with serum lipid levels and that the ratios studied do not provide additional substantial information in women who need weight management.