Unraveling the concealed and calculated cardiovascular risks in diabetes

Abstract

Cardiovascular diseases (CVD) account for substantial morbidity and mortality in patients with type 2 diabetes (T2DM). Those with T2DM carry a three to four fold risk of developing CVD compared to healthy individuals.1 Statistics from developed counties reveal a significant decline in CVD mortality among people without diabetes.2 Despite intensified attempts to control risk factors, CVD mortality in diabetes has increased with a rising trend in the South Asian region.3 With the high incidence of diabetes manifested at a relatively younger age with greater adverse risk factor profiles favoring accelerated atherosclerosis, health authorities in the South Asian countries are facing several dilemmas in controlling CVD.

Epidemiological research highlights the pandemic of diabetes in Sri Lanka.4 In the midst of this pandemic, several new developments have taken place in this arena. Research on these new areas including diagnostic utility of glycated hemoglobin in patients with high CVD risk, performance of CVD prediction tools in therapeutic decision making and value of surrogate markers to detect subclinical atherosclerosis is sparse in the local setting. Applications of some of these modern tools are hampered by the paucity of locally relevant literature. This oration includes a series of clinical research carried out in these new arenas in order to unravel concealed and calculated CVD risks in patients with T2DM. In the first study which is a clinical audit among patients with no previous history of diabetes presenting with acute coronary syndrome (ACS) we tested the value of glycated hemoglobin estimation in unraveling concealed glucose abnormalities. Subsequent studies are based on data obtained from patients screened at a Diabetes Centre in Southern Sri Lanka. This database consisted of a diverse population of patients with T2DM including newly diagnosed and those with varying duration and already under treatment. All patients underwent clinical and laboratory tests recommended by the American Diabetes Association (ADA) for annual screening. Biochemical investigations were carried out in a single laboratory using standard protocols. These studies unraveled significant information on lipid abnormalities among newly diagnosed patients with type 2 diabetes; estimation of cardiovascular risk according to different risk estimation tools and correlation of the cardiovascular risk scores obtained using risk estimation tools with carotid intima media thickness, a clinical surrogate of atherosclerosis.