Managing Cardiovascular Complexities in Patients with Diabetes

Corporate-sponsored Symposium
Supported by an unrestricted educational grant from Merck and Co., Inc.
Friday, June 10, 2005
6:30-8:30 PM

Chair:
Steven M. Haffner, MD

Faculty:
George L. Bakris, MD, FACP
Richard W. Nesto, MD
James R. Sowers, MD, FACE, FACP, FAHA

Reported by Kimberly McFarland, PhD

Cardiovascular complications arise due to the disruption of many physiological processes, in addition to hyperglycemia. Aggressive pharmacologic treatment is required, often using multiple agents, to meet stringent therapeutic goals and improve health outcomes. The renin-angiotensin-aldosterone system (RAAS) causes endothelial dysfunction, which is central to CVD and kidney disease, by increasing systemic blood pressure (BP), glomerular capillary pressure, inflammation, and reactive oxygen species (ROS) production. Because the kidneys are highly vascularized, microalbuminuria signals both impaired kidney and vascular function. In fact, proteinuria is a predictor of stroke in type 2 diabetes patients. Data from several trials indicate that quick and aggressive BP regulation benefits patients; 3 or more agents may be required. RAAS blockade, with angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), or both, can provide renal protection, and physicians should bear in mind that agents which lower both BP and proteinuria provide better protection against end stage renal disease (ESRD)., Finally, while metabolic syndrome and prediabetes define different patient subsets, there is correlation between the two conditions, and patients in both groups can be considered to be at increased risk CVD.,

References

1. Gaeden P, et al. N Engl J Med. 2003;348:383-393.
2. Sowers JR. N Engl J Med. 2002;346:1999-2001.
3. Miettinen H, et al. Stroke. 1996;27:2033-2039.
4. Bakris GL, et al. Am J Kidney Dis. 2000;36:646-661.
5. Ibsen H, et al. J Hypertens. 2004;22:1805-1811.
6. Haffner SM, et al. JAMA. 1990;263:2893-2898.
7. Hunt KJ, et al. Circulation. 2004;110:1251-1257.