Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals.

BACKGROUND: Recent European guidelines on diabetes, prediabetes, and cardiovascular disease developed for the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) significantly changed some concepts on risk stratification, lipid goals, and recommendations for the use of lipid-lowering drugs. The objectives of this work were to describe the lipid-lowering treatment prescribed for patients with diabetes and to determine the percentage of patients that achieved the lipid goals recommended by the 2019 ESC/EASD Guidelines on Diabetes in real and simulated scenarios. METHODS: A multicenter, cross-sectional study was performed. Subjects >18 years with type 2 diabetes were included. The recommendations of the 2019 ESC/EASD Guidelines were followed. The real and simulated (ideal setting using adequate doses of statins ± ezetimibe) scenarios were analyzed. RESULTS: Overall, 528 patients were included. In total, 62.5% of patients received statins (17.1% high intensity). Most patients were stratified as "very high risk" (54.2%) or "high risk" (43.4%). Only 13.3% achieved the double lipid goal (LDL-C and non-HDL-C goals according to the risk categories). In the simulation analysis, the proportion of subjects that did not reach the therapeutic objective decreased in all risk strata, although a considerable proportion of subjects persisted outside the target. CONCLUSION: The difficulty of achieving lipid goals in diabetic patients was considerable when applying the new guidelines. The situation would improve if we optimized treatment, but the prescription of new lipid-lowering drugs could be limited by their high cost.

Cardiovascular Risk Stratification in Patients with Metabolic Syndrome Without Diabetes or Cardiovascular Disease: Usefulness of Metabolic Syndrome Severity Score.

INTRODUCTION: The estimated cardiovascular risk determined by the different risk scores, could be heterogeneous in patients with metabolic syndrome without diabetes or vascular disease. This risk stratification could be improved by detecting subclinical carotid atheromatosis. AIMS: To estimate the cardiovascular risk measured by different scores in patients with metabolic syndrome and analyze its association with the presence of carotid plaque. METHODS: Non-diabetic patients with metabolic syndrome (Adult Treatment Panel III definition) without cardiovascular disease were enrolled. The Framingham score, the Reynolds score, the new score proposed by the 2013 ACC/AHA Guidelines and the Metabolic Syndrome Severity Calculator were calculated. Prevalence of carotid plaque was determined by ultrasound examination. A Receiver Operating Characteristic analysis was performed. RESULTS: A total of 238 patients were enrolled. Most patients were stratified as "low risk" by Framingham score (64%) and Reynolds score (70.1%). Using the 2013 ACC/AHA score, 45.3% of the population had a risk ≥7.5%. A significant correlation was found between classic scores but the agreement (concordance) was moderate. The correlation between classical scores and the Metabolic Syndrome Severity Calculator was poor. Overall, the prevalence of carotid plaque was 28.2%. The continuous metabolic syndrome score used in our study showed a good predictive power to detect carotid plaque (area under the curve 0.752). CONCLUSION: In this population, the calculated cardiovascular risk was heterogenic. The prevalence of carotid plaque was high. The Metabolic Syndrome Severity Calculator showed a good predictive power to detect carotid plaque.

Impacto del ejercicio supervisado en la rigidez arterial

Introducción. Si bien la rigidez arterial es un predictor independiente de mortalidad cardiovascular, el impacto del ejercicio sobre dicha variable no está establecido. El objetivo del estudio fue evaluar el impacto de un programa corto de ejercicio en pacientes con factores de riesgo y/o enfermedad cardiovascular sobre la rigidez arterial. Material y método. Se estudiaron en forma consecutiva pacientes ingresados a un programa de ejercicio supervisado y se los comparó con un grupo control, apareados por edad, sexo, hipertensión arterial y patología cardiovascular. Se midieron la velocidad de onda de pulso (VOP) y otros parámetros de rigidez arterial (método oscilométrico), al inicio y a las 12 semanas. Se estimó la diferencia entre los valores finales e iniciales de las variables arteriográficas (delta). Se efectuó análisis uni y multivariado. Resultados. Se incluyeron 47 pacientes en el grupo ejercicio y 42 controles (edad 62 años, 75% hombres). No hubo diferencias significativas en las variables arteriográficas basales entre ambos grupos. A las 12 semanas, el valor delta VOP fue menor en el grupo ejercicio en comparación con los controles (-0,62 vs 1,07 m/s; p=0,004). En el análisis multivariado, el grupo ejercicio tuvo 1,5 m/s (CI 95% -2,80/-0,21, p=0,02) menos de delta VOP, en comparación con el grupo control. Los valores delta de las demás mediciones no fueron significativamente diferentes entre ambos grupos, excepto la presión arterial sistólica y diastólica que fueron menores en el grupo ejercicio. Conclusión. En resumen, un plan corto de ejercicio podría reducir la rigidez arterial en pacientes con enfermedad cardiovascular y/o factores de riesgo. Se requieren estudios de mayor tamaño, que verifiquen el verdadero impacto de esta intervención en la rigidez arterial.

Impact of supervised exercise program on arterial stiffness Background. Although arterial stiffness is an independent predictor of cardiovascular mortality, the impact of exercise on this variable has not been established. The aim of the study was to evaluate the impact of a short program of exercise in patients with risk factors or cardiovascular disease on arterial stiffness. Material and method.Arterial stiffness was assessed in consecutive patients admitted to a supervised exercise program. They were compared with patients with an age, gender, hypertension and previous cardiovascular disease matched control group. Pulse wave velocity (PWV) and other arterial stiffness parameters (oscillometric method) were measured at baseline and at 12 weeks in both groups. To assess the effect of exercise on arterial stiffness, the changes between these two time points (delta) was compared between groups. Results. We include 47 patients in the exercise group and 42 in the control group (mean age 62 years, 75% male). There were no significant differences in baseline arteriographic variables between groups. At 12 weeks, the delta PWV value was lower in the exercise group compared with controls (-0.62 vs 1.07 m/s, p=0.004). In the multivariate analysis, the delta PWV value was 1.5 m/s lower in the exercise group (CI 95% -2.80/-0.21, p=0.02). Except for systolic and diastolic blood pressure that were lower in the exercise group, delta values of others variables assessed did not differ between both groups. Conclusion.In summary, a short program of supervised exercise may be effective in reducing arterial stiffness in patients with risk factors for and/or cardiovascular disease. Further larger studies to verify the real impact of this intervention on arterial stiffness are required.

Impacto do exercício físico supervisionado sobre a rigidez arterial Introdução. Embora a rigidez arterial é um preditor independente de mortalidade cardiovascular, o impacto do exercício sobre esta variável não está definida. O objetivo do estudo foi avaliar o impacto de um programa de exercício curto em pacientes com fatores de risco e/ou doença cardiovascular na rigidez arterial. Material é método. Estudamos pacientes consecutivos internados em um programa de exercício supervisionado e comparados com um grupo controle pareados por idade, sexo, hipertensão e doença cardiovascular. A velocidade da onda de pulso (VOP) e outros parâmetros de rigidez arterial (método oscilométrico), no início do estudo e 12 semanas foram medidos. Estimou-se a diferença entre o valor final e inicial das variáveis angiográficas (delta). Análises univariada e multivariada foram realizadas. Resultado. Quarenta e sete pacientes no grupo de exercício e 42 controles (idade 62 anos, 75% homens) foram incluídos. Não houve diferenças significativas nas variáveis angiográficas basais entre os grupos. Em 12 semanas, o valor delta VOP foi menor no grupo de exercício em comparação com os controles (-0,62 vs 1,07 m/s; p=0,004). Na análise multivariada, o grupo de exercício tinha (IC 95% -2,80/-0,21; p=0,02) de 1,5 m/s menor que delta VOP em comparação com o grupo controle. Os valores delta de outras medidas não foram significativamente diferentes entre os grupos, com exceção de pressão arterial diastólica e sistólica foram menores no grupo exercício. Conclusão. Em resumo, um plano de exercício curto poderia reduzir a rigidez arterial em pacientes com doença cardiovascular e/ou fatores de risco. Estudos maiores, para verificar o impacto real desta intervenção sobre a rigidez arterial são obrigatórios.

Impacto del ejercicio supervisado en la rigidez arterial

Introducción. Si bien la rigidez arterial es un predictor independiente de mortalidad cardiovascular, el impacto del ejercicio sobre dicha variable no está establecido. El objetivo del estudio fue evaluar el impacto de un programa corto de ejercicio en pacientes con factores de riesgo y/o enfermedad cardiovascular sobre la rigidez arterial. Material y método. Se estudiaron en forma consecutiva pacientes ingresados a un programa de ejercicio supervisado y se los comparó con un grupo control, apareados por edad, sexo, hipertensión arterial y patología cardiovascular. Se midieron la velocidad de onda de pulso (VOP) y otros parámetros de rigidez arterial (método oscilométrico), al inicio y a las 12 semanas. Se estimó la diferencia entre los valores finales e iniciales de las variables arteriográficas (delta). Se efectuó análisis uni y multivariado. Resultados. Se incluyeron 47 pacientes en el grupo ejercicio y 42 controles (edad 62 años, 75% hombres). No hubo diferencias significativas en las variables arteriográficas basales entre ambos grupos. A las 12 semanas, el valor delta VOP fue menor en el grupo ejercicio en comparación con los controles (-0,62 vs 1,07 m/s; p=0,004). En el análisis multivariado, el grupo ejercicio tuvo 1,5 m/s (CI 95% -2,80/-0,21, p=0,02) menos de delta VOP, en comparación con el grupo control. Los valores delta de las demás mediciones no fueron significativamente diferentes entre ambos grupos, excepto la presión arterial sistólica y diastólica que fueron menores en el grupo ejercicio. Conclusión. En resumen, un plan corto de ejercicio podría reducir la rigidez arterial en pacientes con enfermedad cardiovascular y/o factores de riesgo. Se requieren estudios de mayor tamaño, que verifiquen el verdadero impacto de esta intervención en la rigidez arterial.(AU)

Impact of supervised exercise program on arterial stiffness Background. Although arterial stiffness is an independent predictor of cardiovascular mortality, the impact of exercise on this variable has not been established. The aim of the study was to evaluate the impact of a short program of exercise in patients with risk factors or cardiovascular disease on arterial stiffness. Material and method.Arterial stiffness was assessed in consecutive patients admitted to a supervised exercise program. They were compared with patients with an age, gender, hypertension and previous cardiovascular disease matched control group. Pulse wave velocity (PWV) and other arterial stiffness parameters (oscillometric method) were measured at baseline and at 12 weeks in both groups. To assess the effect of exercise on arterial stiffness, the changes between these two time points (delta) was compared between groups. Results. We include 47 patients in the exercise group and 42 in the control group (mean age 62 years, 75% male). There were no significant differences in baseline arteriographic variables between groups. At 12 weeks, the delta PWV value was lower in the exercise group compared with controls (-0.62 vs 1.07 m/s, p=0.004). In the multivariate analysis, the delta PWV value was 1.5 m/s lower in the exercise group (CI 95% -2.80/-0.21, p=0.02). Except for systolic and diastolic blood pressure that were lower in the exercise group, delta values of others variables assessed did not differ between both groups. Conclusion.In summary, a short program of supervised exercise may be effective in reducing arterial stiffness in patients with risk factors for and/or cardiovascular disease. Further larger studies to verify the real impact of this intervention on arterial stiffness are required.(AU)

Impacto do exercício físico supervisionado sobre a rigidez arterial IntroduþÒo. Embora a rigidez arterial é um preditor independente de mortalidade cardiovascular, o impacto do exercício sobre esta variável nÒo está definida. O objetivo do estudo foi avaliar o impacto de um programa de exercício curto em pacientes com fatores de risco e/ou doenþa cardiovascular na rigidez arterial. Material é método. Estudamos pacientes consecutivos internados em um programa de exercício supervisionado e comparados com um grupo controle pareados por idade, sexo, hipertensÒo e doenþa cardiovascular. A velocidade da onda de pulso (VOP) e outros parÔmetros de rigidez arterial (método oscilométrico), no início do estudo e 12 semanas foram medidos. Estimou-se a diferenþa entre o valor final e inicial das variáveis angiográficas (delta). Análises univariada e multivariada foram realizadas. Resultado. Quarenta e sete pacientes no grupo de exercício e 42 controles (idade 62 anos, 75% homens) foram incluídos. NÒo houve diferenþas significativas nas variáveis angiográficas basais entre os grupos. Em 12 semanas, o valor delta VOP foi menor no grupo de exercício em comparaþÒo com os controles (-0,62 vs 1,07 m/s; p=0,004). Na análise multivariada, o grupo de exercício tinha (IC 95% -2,80/-0,21; p=0,02) de 1,5 m/s menor que delta VOP em comparaþÒo com o grupo controle. Os valores delta de outras medidas nÒo foram significativamente diferentes entre os grupos, com exceþÒo de pressÒo arterial diastólica e sistólica foram menores no grupo exercício. ConclusÒo. Em resumo, um plano de exercício curto poderia reduzir a rigidez arterial em pacientes com doenþa cardiovascular e/ou fatores de risco. Estudos maiores, para verificar o impacto real desta intervenþÒo sobre a rigidez arterial sÒo obrigatórios.(AU)