CME: Cardiometabolic Risk, Type 2 Diabetes, & Heart Disease

CME: Cardiometabolic Risk, Type 2 Diabetes, & Heart Disease
Author Information (click to view)

Cecilia C. Low Wang, MD, FACP

Associate Professor of Medicine
Associate Director, Fellowship/Education
Division of Endocrinology, Metabolism and Diabetes
Department of Medicine
University of Colorado Anschutz Medical Campus/School of Medicine

Cecilia C. Low Wang, MD, FACP, has indicated to Physician’s Weekly that she has received grants/research aid from the Department of Veterans Affairs and, in the distant past, has worked as a paid speaker for Merck.

Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  1. Explain the current state of cardiometabolic risk among Americans.
  2. Discuss the modifiable factors that increase cardiometabolic risk in patients with type 2 diabetes and the importance of addressing these factors.
  3. Describe various therapeutic approaches for reducing cardiometabolic risk in patients with type 2 diabetes.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwaugust5.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Cecilia C. Low Wang, MD, FACP
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
 
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Cecilia C. Low Wang, MD, FACP (click to view)

Cecilia C. Low Wang, MD, FACP

Associate Professor of Medicine
Associate Director, Fellowship/Education
Division of Endocrinology, Metabolism and Diabetes
Department of Medicine
University of Colorado Anschutz Medical Campus/School of Medicine

Cecilia C. Low Wang, MD, FACP, has indicated to Physician’s Weekly that she has received grants/research aid from the Department of Veterans Affairs and, in the distant past, has worked as a paid speaker for Merck.

Cardiometabolic risk should be routinely assessed in patients with type 2 diabetes, and multiple prevention and management strategies may be required to achieve goals. Healthcare providers should have conversations with their patients about the connection between diabetes, heart disease, and stroke as well as the benefits of prevention.
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The term cardiometabolic risk refers to having a high 10-year and/or lifetime risk for cardiovascular disease (CVD). Specific causes that can increase cardiometabolic risk include hyperglycemia, hypertension, dyslipidemia, obesity, and insulin resistance. When patients have one or more of these risk factors and are physically inactive or smoke, cardiometabolic risk is further increased. “Patients with type 2 diabetes often have many risk factors associated with cardiometabolic risk,” explains Cecilia C. Low Wang, MD, FACP (Figure). “It’s important to consider cardiometabolic risk as part of a comprehensive approach to patient care.” This allows clinicians to consider multiple disease pathways and risk factors to facilitate earlier intervention.

The State of Risk

According to current estimates, two of every three Americans are overweight or obese, and about 86 million have prediabetes. Nearly half of all adults in the United States have high cholesterol, and about one-third have high blood pressure (BP). “While it’s important to track A1C among patients with type 2 diabetes, it’s also critical to manage BP and cholesterol because these are two of the most important cardio-metabolic risk factors,” Dr. Low Wang says. Research has shown that good BP control can reduce diabetes-related deaths by 32% and lower the risk of stroke by 44% and micro-vascular complications by 37%.

Cardiometabolic-Risk-Diabetes-HD-Callout

Addressing Risk Factors

There are non-modifiable and modifiable cardio-metabolic risk factors to consider when managing patients with type 2 diabetes. Non-modifiable risk factors include age, race and ethnicity, gender, and family history. Modifiable factors include obesity, dyslipidemia, inflammation, hypertension, smoking, physical inactivity, unhealthy diet, and insulin resistance. “Patients should understand that having diabetes means being at higher risk for CVD,” says Dr. Low Wang. “It’s important to address cardiometabolic risk as early as possible.”

Making efforts to manage modifiable risk factors is of the utmost importance, according to Dr. Low Wang. “It’s critical to address risk factors early, especially if patients are overweight or obese and have other risk factors that can be modified with lifestyle modifications and therapies,” she says. “Patients need to understand that while their CVD risk factors may not currently be causing them harm, it’s likely that they will cause problems later in life.”

Preventive Therapeutic Approaches

Lifestyle modifications are paramount to the care of patients with diabetes in order to reduce their overall cardiometabolic risk. Losing weight, increasing physical activity, quitting smoking, and using statins and other medications are important approaches. Glycemic targets should be individualized, with more stringent A1C goals for recently diagnosed patients who have long life expectancies. Less stringent A1C goals should be set for patients with frequent or severe hypoglycemia, those with advanced complications, and those who respond poorly to therapy.

Aspirin therapy is a primary prevention strategy for patients with increased cardiovascular risk, which includes most men aged 50 and older, most women aged 60 and older, and anyone with at least one additional major risk factor. Aspirin can be used as a secondary prevention strategy in those with diabetes who have a history of CVD. In addition to lifestyle modifications, either moderate- or high-dose cholesterol-lowering therapy should be considered for patients with type 2 diabetes, regardless of baseline lipid levels since diabetes itself is a risk factor for heart disease. All patients with diabetes who have overt CVD should be on high-intensity cholesterol-lowering doses.

“Clinicians should ensure that patients recognize the importance of healthy lifestyle behaviors like eating right and exercising regularly, even after they’ve been given medications to address their cardiometabolic risk,” Dr. Low Wang says. “Patients should know why they’re taking the medications they’ve been prescribed and be educated about what they will do to lower their CVD risk. If side effects from these medications are encountered, it’s important to address them quickly to ensure adherence to treatment regimens.”

Routine Assessments Required

Dr. Low Wang says that healthcare teams managing patients with diabetes should routinely assess cardiometabolic risk and treat risk factors as early as possible. “There are many prevention and management strategies that can be implemented to achieve goals,” she says. “In the future, it’s hoped that more research will further assist clinicians as they evaluate and treat patients for cardiometabolic risk factors throughout care. In the meantime, having discussions about risks for CVD and stroke with patients with diabetes can go a long way toward optimizing outcomes.”

Readings & Resources (click to view)

American Diabetes Association. Cardiometabolic risk, type 2 diabetes, and cardiovascular disease. Available at http://professional.diabetes.org/SlideLibraryDetail.aspx?ssPath=Cardiometabolic_Risk_0f775d32-0576-4a32-90e3-198bd4eb469b&ssName=Cardiometabolic_Risk.ppt&ssId=22&ssTitle=Cardiometabolic Risk, Type 2 Diabetes and Cardiovascular Disease.

Brunzell JD, Davidson M, Furberg CD, et al.; American Diabetes Association; American College of Cardiology Foundation. Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care. 2008;31:811–822.

Engelsen Cd, Koekkoek PS, Godefrooij MB, Spigt MG, Rutten GE. Screening for increased cardiometabolic risk in primary care: a systematic review. Br J Gen Pract. 2014;64:e616-e626.

Poon VT, Kuk JL, Ardern CI. Trajectories of metabolic syndrome development in young adults. PLoS One. 2014;9:e111647.

Franch-Nadal J, Mata-Cases M, Vinagre I, et al. Differences in the cardiometabolic control in type 2 diabetes according to gender and the presence of cardiovascular disease: results from the eControl Study. Int J Endocrinol. 2014;2014:131709.

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