It is possible to take action to slow or stop the consequences of cardiovascular disease in diabetes. Now is the time to act.
Diabetes and its cardiovascular complications are a major cause of illness, death and healthcare costs. hese problems are global in perspective and are rapidly worsening.The good news is that it is possible to take action to slow or stop the consequences of cardiovascular disease in diabetes.
Action must be taken on four levels:
Investment in primary and secondary prevention strategies is potentially the most effective measure in the long term, in both human and economic terms. It is necessary to adopt an uncompromising multifactorial approach to prevent or slow the progression of cardiovascular disease in people with diabetes. Fundamental aspects of prevention include:
Primary prevention of diabetes by lifestyle modification has the advantage that it will simultaneously help to reduce other cardiovascular risk factors such as hypertension, obesity and dyslipidaemia.
| Lifestyle behaviour to be promoted |
|---|
| A healthy, balanced diet (less fat, salt, refined sugar, alcohol and calories; more fibre, fruit and vegetables |
| Regular physical activity (eg aerobic exercise) |
| A healthy social life and relaxation techniques to combat stress |
| Smoking cessation |
| Sustained weight loss in the overweight |
This will enable intervention in the early stages of cardiovascular complications. However it must be recognized that this may lead to a short-term rise in the use of resources as a result of an increased identification of new cases. This should be viewed as an advantage rather than a disadvantage, since early detection has obvious long-term benefits.
Programmes should be introduced that are aimed at primary and secondary prevention of diabetes and its cardiovascular complications. These can be integrated or linked with other health or environmental programmes.
Adequate healthcare resources need to be made available not only for prevention but also for the treatment of established diabetes and its cardiovascular complications. This means the provision of essential medical treatment, so that the best possible prognosis can be ensured. At the very least we should aim for a similar decline in heart disease mortality for people with diabetes around the world as that which has been witnessed in people without diabetes in many developed countries in recent years.
Governments: Decision makers need to be made aware of the close link between diabetes and cardiovascular disease and that, if measures are not taken to prevent diabetes in the first place, a global explosion of cardiovascular disease is waiting to happen. Given that there is a lot of overlap in the prevention techniques for the two diseases, investment in prevention can yield a high return.
Healthcare professionals: Cardiovascular risk factors in diabetes have been identified by many recent studies. A number of these risk factors are modifiable and it has been proven possible to reduce their impact dramatically. Healthcare professionals must be made aware of the importance of systematically and aggressively implementing these findings in clinical practice.
Public: People with diabetes in particular need to be aware of the common cardiovascular risk factors and the lifestyle and other measures that can be taken to decrease or delay their chance of developing cardiovascular disease.
Expanded basic and clinical research is needed in order to gain a better understanding of the factors that contribute to the excess risk of premature cardiovascular disease in people with diabetes. In the future new therapies should aim to decrease the cardiovascular risk of people with diabetes to the same level as that of people without diabetes.