AHA: Most Patients with Diabetes Fail to Meet Cardiovascular Health Goals

This article was originally published on PracticalCardiology.com.

Joshua Joseph, MD, MPH

A new statement from the American Heart Association (AHA) is calling attention to gaps in achieving optimal cardiovascular risk factor management among patients with type 2 diabetes.

The statement, which was published on January 10, 2022 in Circulation, suggests fewer than 20% of patients with type 2 diabetes met suggested targets for reducing cardiovascular disease risk and provides recommendations for research and clinical practice to aid in improving the proportion of patients achieving goal.

“This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and to develop new best practices to advance Type 2 diabetes treatment and care and reduce CVD risk,” said Joshua J. Joseph, MD, MPH, chair of the statement writing group and an assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University College of Medicine, in a release from the AHA. “Far too few people – less than 20% of those with Type 2 diabetes – are successfully managing their heart disease risk, and far too many are struggling to stop smoking and lose weight, two key CVD risk factors. Health care professionals, the health care industry and broader community organizations all have an important role to play in supporting people with Type 2 diabetes.”

The 38-page document, which included more than 300 references, was composed by Joseph and a team of 8 other authors on behalf of the AHA Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Arteriosclerosis, Thrombosis, and Vascular Biology, Council on Clinical Cardiology, and Council on Hypertension. The other authors on the writing committee included Vice Chair Prakash Deedwania, MD, Tushar Acharya, MBBS, MPH, David Aguilar, MD, MSc, Deepak L. Bhatt, MD, MPH, Deborah A. Chyun, PhD, RN, Katherine E. Di Palo, PharmD, Sherita H. Golden, MD, MHS, and Laurence S. Sperling, MD.

Based on a review of evidence published through June 2020, the scientific statement was composed with the aim of addressing the gap between existing evidence on lowering cardiovascular risk in patients with diabetes and the reality of cardiovascular risk and risk factors for people with type 2 diabetes in real-world situations. The statement outlines targets for reducing risk through improved glucose management, blood pressure and cholesterol management, physical activity, nutrition, weight management, and lifestyle risk factor management, and psychosocial care.

“Social determinants of health, which includes health-related behaviors, socioeconomic factors, environmental factors and structural racism, have been recognized to have a profound impact on cardiovascular disease and Type 2 diabetes outcomes,” Joseph added. “People with T2D face numerous barriers to health including access to care and equitable care, which must be considered when developing individualized care plans with our patients.”

The AHA highlighted 4 aspects they considered to be of the utmost importance within their press release related to the statement. These included newer avenues for controlling glucose levels, the importance of personalized blood pressure control, the role of lowering cholesterol levels, and re-thinking aspirin use. Within the section highlighting new avenues for controlling glucose levels, statement authors also made note to underscore the cardioprotective benefits observed with new agents, such as GLP-1 receptor agonists and SLGT2 inhibitors.

“Cost may be a barrier to taking some T2D medications as prescribed, however, many of these medications are now more commonly covered by more health insurance plans,” Joseph said. “Another barrier is recognition by patients that these newer T2D medications are also effective in reducing the risk of heart disease, stroke, heart failure and kidney disease. Increasing public awareness about the link between CVD and T2D and provide support, education and tools that help improve T2D and reduce CVD risk are at the core of the Know Diabetes by Heart™ initiative, from the American Heart Association and American Diabetes Association.”

This statement, “Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association,” was published in Circulation.