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)

doi:10.1186/s13098-017-0251-z

Review

. 2017 Jul 14:9:53.

doi: 10.1186/s13098-017-0251-z. eCollection 2017.

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)

Marcello Casaccia Bertoluci^{1

2}, Rodrigo Oliveira Moreira^{3

4

5}, André Faludi⁶, Maria Cristina Izar⁷, Beatriz D Schaan⁸, Cynthia Melissa Valerio³, Marcelo Chiara Bertolami⁶, Ana Paula Chacra⁹, Marcus Vinicius Bolivar Malachias¹⁰, Sérgio Vencio¹¹, José Francisco Kerr Saraiva¹², Roberto Betti⁹, Luiz Turatti⁹, Francisco Antonio Helfenstein Fonseca⁷, Henrique Tria Bianco⁷, Marta Sulzbach⁶, Adriana Bertolami⁶, João Eduardo Nunes Salles¹³, Alexandre Hohl¹⁴, Fábio Trujilho¹⁵, Eduardo Gomes Lima⁹, Marcio Hiroshi Miname⁹, Maria Teresa Zanella¹⁶, Rodrigo Lamounier¹⁷, João Roberto Sá¹⁸, Celso Amodeo⁶, Antonio Carlos Pires¹⁹, Raul D Santos⁹

Affiliations

¹ Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003 Brazil.
² Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903 Brazil.
³ Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rua Moncorvo Filho, 90, Rio de Janeiro, RJ 20211-340 Brazil.
⁴ Faculdade de Medicina de Valença (FMV), Rua Sebastião Dantas Moreira, 40, Valença, RJ 27600-000 Brazil.
⁵ Faculdade de Medicina da Universidade Presidente Antônio Carlos (FAME/UNIPAC), Av. Juiz de Fora, 1100, Juiz De Fora, MG 36048-000 Brazil.
⁶ Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese, 500, São Paulo, SP 04012-180 Brazil.
⁷ Universidade Federal de São Paulo (UNIFESP), Rua Loefgren, 1350, São Paulo, SP 04040-001 Brazil.
⁸ UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903 Brazil.
⁹ Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil.
¹⁰ Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, MG 30130-110 Brazil.
¹¹ Universidade Federal de Goiás (UFG), 1ª Avenida, s/n, Setor Leste Universitário, Goiânia, GO 74605-020 Brazil.
¹² Pontifícia Universidade Católica de Campinas (PUC-Campinas), Av. John Boyd Dunlop, s/n, Campinas, SP 13059-900 Brazil.
¹³ Faculdade de Ciências, Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Jr, 112, São Paulo, SP 01221-020 Brazil.
¹⁴ Universidade Federal de Santa Catarina (UFSC), Rua Profa. Maria Flora Pausewang, s/n, Florianópolis, SC 88040-970 Brazil.
¹⁵ Clínica de Endocrinologia e Metabologia, Av. Tancredo Neves, 1632/708, Salvador, BA 41820-020 Brazil.
¹⁶ UNIFESP, Rua Leandro Dupret, 365, São Paulo, SP 04025-011 Brazil.
¹⁷ Centro de Diabetes de Belo Horizonte, Rua Niquel, 31, Belo Horizonte, MG 30220-280 Brazil.
¹⁸ UNIFESP, Rua Botucatu, 740, São Paulo, SP 04023-002 Brazil.
¹⁹ Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416, São José do Rio Preto, SP 15090-000 Brazil.

PMID: 28725272
PMCID: PMC5512820
DOI: 10.1186/s13098-017-0251-z

Review

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)

Marcello Casaccia Bertoluci et al. Diabetol Metab Syndr. 2017.

. 2017 Jul 14:9:53.

doi: 10.1186/s13098-017-0251-z. eCollection 2017.

Authors

Affiliations

¹ Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003 Brazil.
² Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903 Brazil.
³ Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rua Moncorvo Filho, 90, Rio de Janeiro, RJ 20211-340 Brazil.
⁴ Faculdade de Medicina de Valença (FMV), Rua Sebastião Dantas Moreira, 40, Valença, RJ 27600-000 Brazil.
⁵ Faculdade de Medicina da Universidade Presidente Antônio Carlos (FAME/UNIPAC), Av. Juiz de Fora, 1100, Juiz De Fora, MG 36048-000 Brazil.
⁶ Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese, 500, São Paulo, SP 04012-180 Brazil.
⁷ Universidade Federal de São Paulo (UNIFESP), Rua Loefgren, 1350, São Paulo, SP 04040-001 Brazil.
⁸ UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903 Brazil.
⁹ Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil.
¹⁰ Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, MG 30130-110 Brazil.
¹¹ Universidade Federal de Goiás (UFG), 1ª Avenida, s/n, Setor Leste Universitário, Goiânia, GO 74605-020 Brazil.
¹² Pontifícia Universidade Católica de Campinas (PUC-Campinas), Av. John Boyd Dunlop, s/n, Campinas, SP 13059-900 Brazil.
¹³ Faculdade de Ciências, Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Jr, 112, São Paulo, SP 01221-020 Brazil.
¹⁴ Universidade Federal de Santa Catarina (UFSC), Rua Profa. Maria Flora Pausewang, s/n, Florianópolis, SC 88040-970 Brazil.
¹⁵ Clínica de Endocrinologia e Metabologia, Av. Tancredo Neves, 1632/708, Salvador, BA 41820-020 Brazil.
¹⁶ UNIFESP, Rua Leandro Dupret, 365, São Paulo, SP 04025-011 Brazil.
¹⁷ Centro de Diabetes de Belo Horizonte, Rua Niquel, 31, Belo Horizonte, MG 30220-280 Brazil.
¹⁸ UNIFESP, Rua Botucatu, 740, São Paulo, SP 04023-002 Brazil.
¹⁹ Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416, São José do Rio Preto, SP 15090-000 Brazil.

PMID: 28725272
PMCID: PMC5512820
DOI: 10.1186/s13098-017-0251-z

Abstract

Background: 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.

Main body: 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.

Conclusions: 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.

Keywords: Antiplatelet agents; Blood glucose; Cardiovascular prevention; Cardiovascular screening; Coronary artery disease; Diabetes mellitus; Dyslipidemias; Hypertension; Risk factors.

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References

1. Bertoluci MC, Pimazoni-Netto A, Pires AC, Pesaro AE, Schaan BD, Caramelli B, Polanczyk CA, Junior CV, Gualandro DM, Malerbi DA, et al. Diabetes and cardiovascular disease: from evidence to clinical practice—position statement 2014 of Brazilian Diabetes Society. Diabetol Metab Syndr. 2014;6:58. doi: 10.1186/1758-5996-6-58. - DOI - PMC - PubMed
1. Bertoluci M, Rocha VZ. Cardiovascular risk assessment in patients with diabetes. Diabetol Metab Syndr. 2017;9:1–13. doi: 10.1186/s13098-016-0201-1. - DOI - PMC - PubMed
1. Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. 2006;368:29–36. doi: 10.1016/S0140-6736(06)68967-8. - DOI - PubMed
1. Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med. 2011;171:404–410. doi: 10.1001/archinternmed.2011.2. - DOI - PubMed
1. Li R, O’Sullivan MJ, Robinson J, Safford MM, Curb D, Johnson KC. Family history of myocardial infarction predicts incident coronary heart disease in postmenopausal women with diabetes: the Women’s Health Initiative Observational Study. Diabetes Metab Res Rev. 2009;25:725–732. doi: 10.1002/dmrr.1010. - DOI - PMC - PubMed

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[1] Bertoluci MC, Pimazoni-Netto A, Pires AC, Pesaro AE, Schaan BD, Caramelli B, Polanczyk CA, Junior CV, Gualandro DM, Malerbi DA, et al. Diabetes and cardiovascular disease: from evidence to clinical practice—position statement 2014 of Brazilian Diabetes Society. Diabetol Metab Syndr. 2014;6:58. doi: 10.1186/1758-5996-6-58. - DOI - PMC - PubMed

[2] Bertoluci MC, Pimazoni-Netto A, Pires AC, Pesaro AE, Schaan BD, Caramelli B, Polanczyk CA, Junior CV, Gualandro DM, Malerbi DA, et al. Diabetes and cardiovascular disease: from evidence to clinical practice—position statement 2014 of Brazilian Diabetes Society. Diabetol Metab Syndr. 2014;6:58. doi: 10.1186/1758-5996-6-58. - DOI - PMC - PubMed

[3] Bertoluci M, Rocha VZ. Cardiovascular risk assessment in patients with diabetes. Diabetol Metab Syndr. 2017;9:1–13. doi: 10.1186/s13098-016-0201-1. - DOI - PMC - PubMed

[4] Bertoluci M, Rocha VZ. Cardiovascular risk assessment in patients with diabetes. Diabetol Metab Syndr. 2017;9:1–13. doi: 10.1186/s13098-016-0201-1. - DOI - PMC - PubMed

[5] Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. 2006;368:29–36. doi: 10.1016/S0140-6736(06)68967-8. - DOI - PubMed

[6] Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. 2006;368:29–36. doi: 10.1016/S0140-6736(06)68967-8. - DOI - PubMed

[7] Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med. 2011;171:404–410. doi: 10.1001/archinternmed.2011.2. - DOI - PubMed

[8] Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med. 2011;171:404–410. doi: 10.1001/archinternmed.2011.2. - DOI - PubMed

[9] Li R, O’Sullivan MJ, Robinson J, Safford MM, Curb D, Johnson KC. Family history of myocardial infarction predicts incident coronary heart disease in postmenopausal women with diabetes: the Women’s Health Initiative Observational Study. Diabetes Metab Res Rev. 2009;25:725–732. doi: 10.1002/dmrr.1010. - DOI - PMC - PubMed

[10] Li R, O’Sullivan MJ, Robinson J, Safford MM, Curb D, Johnson KC. Family history of myocardial infarction predicts incident coronary heart disease in postmenopausal women with diabetes: the Women’s Health Initiative Observational Study. Diabetes Metab Res Rev. 2009;25:725–732. doi: 10.1002/dmrr.1010. - DOI - PMC - PubMed

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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)

Affiliations

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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