What is Cardiovascular risk?
Is your risk of having heart attacks or strokes. Diabetes can increase your risk by as much as fur times for heart attacks and stroke.
What can be done to reduce the cardiovascular risk?
There’s controversy about how aggressively to treat risk factors for heart attack and strokes in diabetes patients.
For many years we were told that type 2 diabetes is a “cardiovascular risk equivalent” Meaning most diabetes patients have a similar risk for heart attack and strokes as patients who already had heart attack or stroke.
Diabetes does increase risks for heart attack and stroke but how much depends on how long the patient has been diabetic, age at diagnosis, and other risk factors.
In fact, most newly diagnosed type 2 patients have a lower cardiovascular disease risk than patients with a previous heart attack. For example, men diagnosed after age 60 who have diabetes for only 5 years have about half the risk of a cardiac event as men diagnosed before age 60 who have diabetes for 16 years.
Use of Aspirin to reduce Cardiovascular Risk
Aspirin used to be recommended for diabetes patients over age 40. Now new guidelines have Recommend aspirin for men over 50 and women over 50 with diabetes with at least one more risk factor such as smoking or hypertension. Because cardiovascular benefit doesn’t always outweigh the risk of a GI bleed, when to start aspirin is important.
Aspirin should be recommended in patients with a previous cardiovascular event such as heart attacks and strokes.
Blood pressure guidelines suggest a lower but this is controversial even among experts. New guidelines for blood pressure were released in November of 2017 which recommend lower blood pressure numbers for the younger patients.
Lower Blood pressures may be associated with more side effects. Suggest aiming for less than 130/80 mm Hg if it can be achieved without significant side effects, especially for patients with proteinuria (protein in the urine) or at high risk for stroke.
Cholesterol guidelines suggest lowering the Bad cholesterol (LDL). Statins (cholesterol medications) improve cardiovascular outcomes in diabetes patients.
