Title |
Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)
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Published in |
Diabetology & Metabolic Syndrome, July 2017
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DOI | 10.1186/s13098-017-0251-z |
Pubmed ID | |
Authors |
Marcello Casaccia Bertoluci, Rodrigo Oliveira Moreira, André Faludi, Maria Cristina Izar, Beatriz D. Schaan, Cynthia Melissa Valerio, Marcelo Chiara Bertolami, Ana Paula Chacra, Marcus Vinicius Bolivar Malachias, Sérgio Vencio, José Francisco Kerr Saraiva, Roberto Betti, Luiz Turatti, Francisco Antonio Helfenstein Fonseca, Henrique Tria Bianco, Marta Sulzbach, Adriana Bertolami, João Eduardo Nunes Salles, Alexandre Hohl, Fábio Trujilho, Eduardo Gomes Lima, Marcio Hiroshi Miname, Maria Teresa Zanella, Rodrigo Lamounier, João Roberto Sá, Celso Amodeo, Antonio Carlos Pires, Raul D. Santos |
Abstract |
Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes. The Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy. Diabetes is a heterogeneous disease. Although cardiovascular risk is increased in most patients, those without risk factors or evidence of sub-clinical atherosclerosis are at a lower risk. Optimal management must rely on an approach that will cover both cardiovascular disease prevention in individuals in the highest risk as well as protection from overtreatment in those at lower risk. Thus, cardiovascular prevention strategies should be individualized according to cardiovascular risk while intensification of treatment should focus on those at higher risk. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
Spain | 4 | 29% |
Brazil | 3 | 21% |
United Kingdom | 1 | 7% |
United States | 1 | 7% |
Paraguay | 1 | 7% |
Chile | 1 | 7% |
Unknown | 3 | 21% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 10 | 71% |
Practitioners (doctors, other healthcare professionals) | 3 | 21% |
Scientists | 1 | 7% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 168 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 20 | 12% |
Student > Bachelor | 18 | 11% |
Student > Master | 16 | 10% |
Other | 11 | 7% |
Student > Doctoral Student | 11 | 7% |
Other | 29 | 17% |
Unknown | 63 | 38% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 57 | 34% |
Nursing and Health Professions | 11 | 7% |
Biochemistry, Genetics and Molecular Biology | 6 | 4% |
Social Sciences | 5 | 3% |
Agricultural and Biological Sciences | 4 | 2% |
Other | 19 | 11% |
Unknown | 66 | 39% |