Recognizing CV risk factors in patients with type 2 diabetes

When treating your adult patients with T2D, are you considering that patients may be forgetting to mention certain lifestyle factors that may impact your treatment decisions? Their cardiovascular (CV) risk may be greater than you both realize. Below are some modifiable and non-modifiable factors that you may be overlooking when talking to your patients with T2D. As you go through the following questions, and review the patient profiles below, consider whether you see patients in your practice with similar CV risk.

Explore patient profiles ▾

All patient profiles are for illustrative purposes only.

When it comes to CV risk, sometimes there is more to the story

What do these patient stories have in common with your own?

Hypothetical patient case studies.

Meet Carla


61 years old
Restaurant owner
10 years with type 2 diabetes

Not an actual patient.

A1C: 8.1%
TG: 206 mg/dL
HDL: 37 mg/dL
BMI: 30
LDL: 108 mg/dL
Blood pressure: 136/70 mm Hg

CV medication: lisinopril 20 mg, simvastatin 20 mg

Anti-hyperglycemic medication: metformin 1000 mg BID

Additional comorbidities: Prior myocardial infarction, retinopathy

Other considerations: Even after her heart attack, Carla struggles to maintain her weight. She is always sampling world-class dishes and working long hours make exercise difficult. Carla used to be a regular smoker, but quit once she realized it was even more problematic when added to her T2D diagnosis.

Meet Carla


61 years old
Restaurant owner
10 years with type 2 diabetes

Not an actual patient.

A1C: 8.1%
TG: 206 mg/dL
HDL: 37 mg/dL
BMI: 30
LDL: 108 mg/dL
Blood pressure: 136/70 mm Hg

CV medication: lisinopril 20 mg, simvastatin 40 mg

Anti-hyperglycemic medication: metformin 1000 mg BID

Additional comorbidities: Prior myocardial infarction, retinopathy

Other considerations: Even after her heart attack, Carla struggles to maintain her weight. She is always sampling world-class dishes and working long hours make exercise difficult. Carla used to be a regular smoker, but quit once she realized it was even more problematic when added to her T2D diagnosis.

Meet Jon


52 years old
High school teacher
6 years with type 2 diabetes

Not an actual patient.

A1C: 7.5%
TG: 180 mg/dL
HDL: 35 mg/dL
BMI: 34
LDL: 129 mg/dL
Blood pressure: 130/80 mm Hg

CV medication: hydrochlorothiazide 50 mg, simvastatin 80 mg, aspirin 80 mg

Anti-hyperglycemic medication: metformin 1000 mg BID, glimepiride 2 mg

Additional comorbidities: Moderate renal impairment (eGFR 45), prior myocardial infarction

Other considerations: When Jon is on breaks from school, his routine changes a lot—and he does not always remember to take his medication.

Meet Jon


52 years old
High school teacher
6 years with type 2 diabetes

Not an actual patient.

A1C: 7.5%
TG: 180 mg/dL
HDL: 35 mg/dL
BMI: 32
LDL: 80 mg/dL
Blood pressure: 130/80 mm Hg

CV medication: hydrochlorothiazide 50 mg, simvastatin 40 mg, aspirin 80 mg

Anti-hyperglycemic medication: metformin 1000 mg BID, glimepiride 2 mg

Additional comorbidities: Moderate renal impairment (eGFR 45), prior myocardial infarction

Other considerations: When Jon is on breaks from school, his routine changes a lot—and he does not always remember to take his medication.

Meet Anna


65 years old
Family lawyer
13 years with type 2 diabetes

Not an actual patient.

A1C: 7.1%
TG: 200 mg/dL
HDL: 40 mg/dL
BMI: 28
LDL: 170 mg/dL
Blood pressure: 125/80 mm Hg

CV medication: HCTZ 25 mg, lisinopril 20 mg, atorvastatin 20 mg

Anti-hyperglycemic medication: metformin 1500 mg + PGZ 30 mg

Additional comorbidities: Peripheral artery disease, ankle-brachial index <0.9

Other considerations: Anna’s father had a fatal heart attack when he was only 48. That is why she is so careful to stay on track with her treatment plan.

Meet Anna


65 years old
Family lawyer
13 years with type 2 diabetes

Not an actual patient.

A1C: 7.1%
TG: 130 mg/dL
HDL: 50 mg/dL
BMI: 28
LDL: 90 mg/dL
Blood pressure: 125/80 mm Hg

CV medication: HCTZ 25 mg, lisinopril 20 mg, atorvastatin 20 mg

Anti-hyperglycemic medication: metformin 500 mg + sitagliptin 50 mg

Additional comorbidities: Peripheral artery disease, ankle-brachial index <0.9

Other considerations: Anna’s father had a fatal heart attack when he was only 48. That is why she is so careful to stay on track with her treatment plan. 

Consider how to help lower A1C and reduce CV risk for your patients with T2D and established CVD

Guiding the discussion: the link between T2D + CV risk

Answering common questions about CV risk from your patients

Many patients do not realize there is such a strong link between T2D and CV risk, but it’s important that they understand this link exists.10 Being prepared with simple, straightforward answers can help you put them at ease. Here are some quick answers to some common questions they may have.

Download a printable version of these discussion tips for quick reference

What is the connection between type 2 diabetes and my heart?


The longer you have type 2 diabetes, the higher your risk for experiencing a CV event, which is why managing your diabetes and taking any prescribed treatments are key.10,12 Your risk of another CV event, such as a heart attack or stroke, is greater after you’ve already had a CV event, so we will work together and do everything we can to reduce your risk.7

How do I know if I’m at high risk for a heart attack or stroke?


Your risk is a combination of modifiable and non-modifiable factors. Things like race and family history play a role, but it is more important to focus on the things you can change. Those are known as lifestyle factors. A high BMI, high cholesterol, poor diet, and smoking contribute to a higher risk of a CV event, but together, we can look for ways to reduce your risk.5

How can I reduce my risk for cardiovascular disease?


Managing your lifestyle factors and choosing the right treatments with help from your care team go a long way towards reducing cardiovascular risk. Making dietary changes, staying active, losing weight, limiting alcohol consumption, and quitting smoking may all make a significant difference.5,6 There are also treatment options available that lower A1C and reduce CV risk.3

If I’m on other heart medications, like medications for blood pressure and cholesterol, am I still at risk?


It’s important to continue taking your medications, because controlling your diabetes and heart conditions is vital to keeping you healthy.1 But even though treatment can reduce your risk, it is not altogether eliminated.13,14 That’s why managing your lifestyle factors, in conjunction with other treatments, is key to reducing your risk of CV event.1,3

Is it true that I’m still at risk for heart attack or stroke even if I’ve reached my A1C goal?


Even though reaching your A1C goal makes a positive impact, there is still a residual risk.13,14 Patients with T2D are 2 to 4 times more likely to develop cardiovascular disease than those without T2D.9 This makes communication with your care team even more important. Familiarize yourself with warning signs and do your best to stay on track with your treatment plan.

Is there a treatment option that might be appropriate for me?


Every patient is different, so we will find something that makes sense for your lifestyle, conditions, and needs. There are treatment options available that help lower A1C and reduce CV risk simultaneously.3

References:

  1. American Heart Association. Lifestyle changes for heart attack prevention. http://www.heart.org/HEARTORG/Conditions/HeartAttack/LifeAfteraHeartAttack/Lifestyle-Changes-for-Heart-Attack-Prevention_UCM_303934_Article.jsp#.WmtgI66nHDc. Accessed September 13, 2018.
  2. Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, del Cañizo-Gómez FJ. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diabetes. 2014;5(4):444-470.
  3. American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):S1-S172.
  4. Centers for Disease Control and Prevention. Losing Weight. https://www.cdc.gov/healthyweight/losing_weight/index.html. Accessed August 27, 2018.
  5. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67-e492.
  6. American Heart Association. Understand Your Risks to Prevent a Heart Attack. https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack. Accessed August 26, 2018.
  7. van der Heijden AAWA, Van’t Riet E, Bot SDM, et al. Risk of a recurrent cardiovascular event in individuals with type 2 diabetes or intermediate hyperglycemia. Diabetes Care. 2013;36:3498-3502.
  8. U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. A report of the surgeon general. Rockville, MD: Dept. of Health and Human Services, Public Health Service, Office of Surgeon General. 2010:1-706.
  9. American Heart Association. Smoking & cardiovascular disease (heart disease). http://www.heart.org/HEARTORG/HealthyLiving/QuitSmoking/QuittingResources/Smoking-Cardiovascular-Disease-Heart-Disease_UCM_305187_Article.jsp#.W5lExZNKj-Y. Accessed September 12, 2018.
  10. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus. Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus-mechanisms, management, and clinical considerations. Circulation. 2016;133:2459-2502.
  11. Fox CS, Sullivan L, D’Agostino RB Sr, Wilson PWF; the Framingham Heart Study. The significant effect of diabetes duration on coronary heart disease mortality. Diabetes Care. 2004;27(3):704-708.
  12. Halter JB, Musi N, McFarland Horne F, et al. Diabetes and cardiovascular disease in older adults: current status and future directions. Diabetes. 2014;63:2578-2589.
  13. Gerstein HC, Miller ME, Genuth S, et al; ACCORD Study Group. Long-term effects on intensive glucose lowering on cardiovascular outcomes. N Engl J Med. 2011;364:8181-828.
  14. Stolar M. Glycemic control and complications in type 2 diabetes mellitus. Am J Med. 2010;123: S3-S11.