Type 2 diabetes is an increasingly common but often overlooked disease that is linked, among other things, to lifestyle. It can have serious long-term consequences and is a high risk factor for cardiovascular events.
Classic cardiovascular risk factors have a multiplier effect in people with diabetes. These include high blood pressure, excess lipids (cholesterol and triglycerides) in the blood or smoking. In total, adults with diabetes are 2 to 3 times more likely than the rest of the population to develop cardiovascular disease.
But fortunately, there are prevention strategies.
Cardiovascular Risk: An Important Complication of Type 2 Diabetes
Populations that have had type 2 diabetes for several years are considered to have an increased cardiovascular risk compared to populations without diabetes. Indeed, chronic hyperglycemia can contribute to the premature aging of the arteries and in particular to the process of atherosclerosis which progressively clogs the arteries and exposes to cardiovascular accidents. Furthermore, the cardiovascular risk observed in type 2 diabetic populations may also be related to metabolic conditions at risk such as hypertension, hypercholesterolemia and android overweight, which are more frequently observed in the presence of type 2 diabetes.
This higher cardiovascular risk than in the general population explains the increased prevalence in the type 2 diabetic population of a number of cardiovascular complications. These complications include angina pectoris and myocardial infarction when the coronary arteries are affected, stroke when the cerebral or cerebral arteries are affected, or obliterative arterial disease of the lower limbs, which can result in pain when walking, risk of gangrene and even amputation if the arteries of the lower limbs are blocked. It should be noted, however, that these cardiovascular complications have greatly diminished over the last 30 years, particularly in diabetic populations. Thus, in the United States, while there is still an excess risk of diabetes today, the prevalence of myocardial infarction has decreased by more than 65% in diabetic patients compared to 32% in non-diabetic populations. Improved management of the various cardiovascular risk factors in diabetic patients (hyperglycemia, hypercholesterolemia, arterial hypertension) and more frequent use of certain treatments (statins, enzyme conversion inhibitors, low-dose aspirin, etc.) explain this favorable trend in recent years.
Indeed, when treating patients, the diabetologist will not only help to ensure good glycemic control but will also ensure, like the cardiologist, that all cardiovascular risk factors are optimally controlled. It is therefore frequent that it is the diabetologist who starts a treatment to control lipids or blood pressure or who proposes an aid to stop smoking or to lose weight. In diabetology, glycemic control objectives are personalized. Thus, diabetic patients with advanced cardiovascular complications have an HbA1c target close to 8% while avoiding hypoglycemia, whereas the usual target is lower at 7% or even 6.5% for some patients.
Among the measures recommended to limit the risk of cardiovascular events in the type 2 diabetic population, the adoption of a healthy lifestyle is paramount. This means regular physical activity adapted to the medical condition, a fight against sedentary lifestyles (e.g. limiting the amount of time spent sitting down each day), smoking cessation if necessary, and an adapted diet. Limiting the intake of certain fats, such as saturated and trans fatty acids, is recommended. The “Mediterranean diet”, rich in fibre (fruit, vegetables and legumes), cereals, fish, white meat and oleaginous fruit, has been proven to reduce the occurrence of cardiovascular events and can therefore be recommended for populations most at risk. These various lifestyle changes can be difficult to implement and therefore require encouragement and support from all the medical and paramedical actors who accompany type 2 diabetic patients.
Among drug treatments, the presence of a history of cardiovascular events or the evaluation of a high cardiovascular risk may lead to the prescription of a certain number of molecules that have scientifically proven to reduce major cardiovascular events; This is the case for statins, for the treatment of hypercholesterolemia, for certain classes of anti-hypertensive treatments such as beta-blockers or enzyme conversion inhibitors, or for anti-platelet treatments such as aspirin. With regard to hypoglycemic treatments for diabetes, since 2008 there has been an obligation to scientifically demonstrate that any new treatment for diabetes is not deleterious from a cardiovascular point of view. While this has not been fully demonstrated for older classes of hypoglycemic agents such as hypoglycemic sulfonamides, other newer classes of drugs have demonstrated cardiovascular safety. These cardiovascular studies with type 2 diabetes treatments have also shown that certain hypoglycemic treatments can protect against risk by reducing the occurrence of cardiovascular events.
In summary, appropriate and optimised management of type 2 diabetes requires a good assessment of cardiovascular risk, advice and encouragement on healthy lifestyle habits, a personalised glycaemic target and the use of medication if necessary. This management must mobilise all those involved in the care of the diabetic patient and follow the principles of shared medical decision making to ensure adherence to the proposed care plan.