The last half of the last century saw a dramatic increase in the prevalence of obesity, insulin resistance, and overt diabetes, leading to an increase in coronary heart disease and heart failure.

“The percentage of diabetic patients who end up with cardiovascular events exceeds 70%. Diabetic men have 3 times higher mortality from cardiovascular disease than non-diabetics, while the rate for women is even higher.

Diabetes mellitus is, therefore, a metabolic condition, which is equivalent to a set of early cardiovascular complications with a common denominator of chronic hyperglycemia. However, elevated blood glucose is not the only problem. Type 2 diabetes is a chronic disease that causes hyperinsulinemia and insulin resistance that often remains undiagnosed for several years until its complications appear” says Mr. Ilias M. Tsougos Cardiologist MD, PhD Director of the 6th Cardiology Clinic, HYGEIA, Scientific Associate HealthSpot Diagnostic Centers.

“Surprisingly many studies and meta-analyses have failed to demonstrate an improvement in cardiovascular risk with intensification of glycemic control. An example is the ADVANCE and ACCORD studies, which caused concern by showing that in high-risk patients a strict glycated hemoglobin (HbA1c) target may increase mortality due to an increased incidence of severe hypoglycaemia without improving macroangiopathy.

So not only does glycemic control (which most patients believe) matter in terms of macroangiopathy and microangiopathy, but we should focus more on addressing all the other risk factors. That is, intensive regulation of sugar alongside intensive regulation of arterial hypertension, blood cholesterol levels as well as smoking cessation,” he adds.

Recently it has been shown that a very important role in patient survival is played by a specific group of antidiabetic drugs regardless of good blood glucose regulation. “So the first antidiabetic drugs that reduce cardiovascular mortality in type 2 diabetics, but also in non-diabetic patients who present an increased cardiovascular risk, are empagliflozin and dapagliflozin. This class of drugs works by blocking the activity of the SGLT-2 protein in the kidneys, thereby causing sugar to be excreted from the blood into the urine. In studies of these drugs, overall mortality was reduced by approximately 30% and cardiovascular mortality by 35%,” he points out.

The results are considered revolutionary because they show that in addition to reducing sugar and Hb A1c, the drug that reduces them is also important.

“In conclusion, the initial approach and treatment of diabetic heart disease should always include instructions for diet-weight loss and exercise. Quitting smoking is essential. With regard to drug intervention and taking into account the progressive nature of the disease and the proven effectiveness of early intensive treatment, current treatment strategies are currently being re-evaluated.

Overall, the type of treatment and the overall multifactorial treatment of patients should be individualized and the benefits should be evaluated in relation to its side effects” concludes Mr. Tsougos.

*HealthSpot diagnostic centers operate a specialized Cardiometabolic Department for the holistic treatment of cardiometabolic diseases such as diabetes mellitus and dyslipidemias.