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)

被引：43

作者：

Bertoluci, Marcello Casaccia ^{[1
,2
]}

Moreira, Rodrigo Oliveira ^{[3
,4
,5
]}

Faludi, Andre ^{[6
]}

Izar, Maria Cristina ^{[7
]}

Schaan, Beatriz D. ^{[8
]}

Valerio, Cynthia Melissa ^{[3
]}

Bertolami, Marcelo Chiara ^{[6
]}

Chacra, Ana Paula ^{[9
]}

Bolivar Malachias, Marcus Vinicius ^{[10
]}

Vencio, Sergio ^{[11
]}

Kerr Saraiva, Jose Francisco ^{[12
]}

Betti, Roberto ^{[9
]}

Turatti, Luiz ^{[9
]}

Helfenstein Fonseca, Francisco Antonio ^{[7
]}

Bianco, Henrique Tria ^{[7
]}

Sulzbach, Marta ^{[6
]}

Bertolami, Adriana ^{[6
]}

Nunes Salles, Joao Eduardo ^{[13
]}

Hohl, Alexandre ^{[14
]}

Trujilho, Fabio ^{[15
]}

Lima, Eduardo Gomes ^{[9
]}

Miname, Marcio Hiroshi ^{[9
]}

Zanella, Maria Teresa ^{[18
]}

Lamounier, Rodrigo ^{[16
]}

Sa, Joao Roberto ^{[19
]}

Amodeo, Celso ^{[6
]}

Pires, Antonio Carlos ^{[17
]}

Santos, Raul D. ^{[9
]}

机构：

[1] Univ Fed Rio Grande do Sul, Dept Med Interna, Fac Med, Rua Ramiro Barcelos 2400, BR-90035003 Porto Alegre, RS, Brazil

[2] Univ Fed Rio Grande do Sul, Hosp Clin Porto Algere, Serv Med Interna, Rua Ramiro Barcelos 2350, BR-90035003 Porto Alegre, RS, Brazil

[3] Inst Estadual Diabet & Endocrinol Luiz Capriglion, Rua Moncorvo Filho 90, BR-20211340 Rio De Janeiro, Brazil

[4] Fac Med Valenca, Rua Sebastiao Dantas Moreira 40, BR-27600000 Valenca, Brazil

[5] Univ Presidente Antonio Carlos FAME UNIPAC, Fac Med, Av Juiz de Fora 1100, BR-36048000 Juiz De Fora, MG, Brazil

[6] Inst Dante Pazzanese Cardiol, Av Dante Pazzanese 500, BR-04012180 Sao Paulo, Brazil

[7] Univ Fed Sao Paulo UNIFESP, Rua Loefgren 1350, BR-04040001 Sao Paulo, Brazil

[8] Univ Fed Rio Grande do Sul, Rua Ramiro Barcelos 2350, BR-90035903 Porto Alegre, RS, Brazil

[9] Univ Sao Paulo, Av Dr Eneas de Carvalho Aguiar 44, BR-05403000 Sao Paulo, Brazil

[10] Fac Ciencias Med Minas Gerais, Alameda Ezequiel Dias 275, BR-30130110 Belo Horizonte, MG, Brazil

[11] Univ Fed Goias, Setor Leste Univ Goiania, 1 Avenida S-N, BR-74605020 Goiania, Go, Brazil

[12] Pontificia Univ Catolica Campinas, Av John Boyd Dunlop S-N, BR-13059900 Campinas, SP, Brazil

[13] Med Santa Casa Sao Paulo, Fac Ciencias, Rua Dr Cesario Motta Jr 112, BR-01221020 Sao Paulo, Brazil

[14] Univ Fed Santa Catarina, Rua Profa Maria Flora Pausewang S-N, BR-88040970 Florianopolis, SC, Brazil

[15] Clin Endocrinol & Metabol, Av Tancredo Neves 1632-708, BR-41820020 Salvador, BA, Brazil

[16] Ctr Diabet Belo Horizonte, Rua Niquel 31, BR-30220280 Belo Horizonte, MG, Brazil

[17] Fac Med Sao Jose Rio Preto, Av Brg Faria Lima 5416, BR-15090000 Sao Jose Do Rio Preto, SP, Brazil

[18] Univ Fed Sao Paulo, Rua Leandro Dupret 365, BR-04025011 Sao Paulo, SP, Brazil

[19] Univ Fed Sao Paulo, Rua Botucatu 740, BR-04023002 Sao Paulo, SP, Brazil

来源：

DIABETOLOGY & METABOLIC SYNDROME | 2017年 / 9卷

关键词：

Diabetes mellitus; Cardiovascular prevention; Cardiovascular screening; Blood glucose; Risk factors; Coronary artery disease; Dyslipidemias; Hypertension; Antiplatelet agents; CORONARY-HEART-DISEASE; LOWERING LDL CHOLESTEROL; ALL-CAUSE MORTALITY; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; ACUTE MYOCARDIAL-INFARCTION; RANDOMIZED CONTROLLED-TRIAL; INTENSIVE INSULIN THERAPY; ABDOMINAL AORTIC-ANEURYSM; INTIMA-MEDIA THICKNESS; HIGH-RISK PATIENTS;

D O I：

10.1186/s13098-017-0251-z

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：36

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