Experts call it the multiplicative effect. Cardiovascular risk factors do not add up their potential to damage the arteries and therefore put the heart at risk, but they multiply them. This is why we need to join forces against the enemies of the heart. to recommend it are the experts of Italian Society of Cardiovascular Prevention (Siprec) gathered at the congress. “The new dimension of the therapeutic management of cardiovascular diseases in diabetes and in particular of heart failure, as has been repeatedly confirmed by the results of large recent international trials – he explains. Massimo Volpe, president of Siprec – opens unexplored spaces for the alliance between cardiologists and diabetologists in the management of this condition which affects almost 4 million Italians. On the other hand, the heart of people with diabetes deserves particular attention because this condition doubles the risk of incurring a coronary disease, an ischemic stroke and exposes them to increased mortality from cardiovascular causes “.
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Reduce the risks
The goal, therefore, is to reduce the risks. But how can this be done? The answer lies in the personalization of the approach. According to Agostino Consoli, President of the Italian Society of Diabetology, “an optimal control of cholesterol, hypertension, weight and of course blood glucose is needed, especially through the use of latest generation drugs, such as SGLT2-inhibitors and GLP-1 analogues that , in clinical studies, have shown great effectiveness in reducing new cases and hospitalizations for heart failure and the risk of cardiovascular mortality. And it is for this reason that the European scientific societies of diabetes (EASD) and cardiology (ESC) have indicated as a first step in the treatment of people with diabetes at high cardiovascular risk, therapy with SGLT2-inhibitors or with GLP-1 analogues. These treatments are particularly suitable for the 30% of people with diabetes who have already presented a cardio or cerebral event. vascular disease or have heart failure; unfortunately, less than half of these patients are currently being treated with these anti-diabetes therapies innovative, real heart-savers “.
Let me be clear: to obtain these results maximum collaboration between specialists is required and patients in these conditions must be managed jointly by the cardiologist and the diabetologist. This is also recalled by the document “Management of cardio or cerebrovascular risk in diabetes” developed by the Italian Society of Diabetology together with the Italian Society of Cardiology.
Drugs
In this panorama, obviously, there are not only innovative drugs but also some historical cornerstones of cardiovascular prevention, such as acetylsalicylic acid. “Prescribing low-dose aspirin in people with type 2 diabetes – reports Claudio Ferri, Professor of Internal Medicine at the University of L’Aquila and director of the Uoc of Internal Medicine and Nephrology, at the San Salvatore Hospital in the Abruzzo city. – it must always be done in secondary prevention, that is after a cardiovascular disease has occurred, but it can also be done in primary prevention, provided that the patient is at least 50 years old and / or his diabetes has a duration of at least 10 years or is associated with other risk factors or organ damage is present (eg kidney or heart) “.
Preventing thrombosis, strokes and heart attacks
The objective of this approach is the tendency of their platelets to “bind” to each other (the so-called platelet hyperaggregability), thus promoting the onset of thrombosis, an event at the basis of strokes and heart attacks. But be warned: even this approach is not for everyone. The administration of aspirin in primary prevention is no longer supported by the guidelines in the general population and in diabetic subjects less than 50 years old (or with a disease duration of less than 10 years) because in low-risk subjects the possibility of an undesirable event (e.g. gastrointestinal bleeding) outweighs the benefits (prevention of cardiovascular events).
Aspirin after stroke
The case of secondary prevention is different: after a stroke or a heart attack everyone – except for exceptional contraindications – must take aspirin (or another antiplatelet agent or the combination of two antiplatelet agents). “Wanting to simplify – concludes Ferri – in primary prevention, aspirin can be recommended to people with diabetes and a cardiovascular risk at least” high “. However, about 90% of Italians with diabetes have a” high “or” very high “cardiovascular risk “(against 15-20% of the general population, obviously excluding the very young).
The risks for those with diabetes
The patient, in particular, must know that his level of risk is also defined by the duration of the diabetic disease: a patient with diabetes mellitus for at least 10 years, for example, has by definition a high risk. Therefore, the vast majority of patients with type 2 diabetes mellitus, with the sole exception perhaps of those under the age of 50, have by definition at least a “high” risk and are eligible for aspirin prescription in primary prevention. In addition to this, beyond the duration of the disease, it is sufficient to have at least one other cardiovascular factor (such as hypertension, present in eight out of ten diabetics, high cholesterol or excess weight) to reach the “high risk” range. “.”
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