Management of Cardiovascular Disease Risk Factors in Older Adults with Type 2 Diabetes Mellitus: 2002-2012 Literature Review
Type 2 diabetes mellitus (DM) is one of the most common chronic conditions in older adults and is often accompanied by comorbidities and geriatric syndromes. The management of cardiovascular disease risk factors in older adults with DM is important to clinicians. The literature was reviewed from 200...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2013-11, Vol.61 (11), p.2027-2037 |
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| creator | Moreno, Gerardo Mangione, Carol M. |
| description | Type 2 diabetes mellitus (DM) is one of the most common chronic conditions in older adults and is often accompanied by comorbidities and geriatric syndromes. The management of cardiovascular disease risk factors in older adults with DM is important to clinicians. The literature was reviewed from 2002 to 2012 to provide an American Geriatrics Society expert panel with an evidence base for updating and making new recommendations for improving the care of older adults with type 2 DM. This review includes only the domains of the management of blood pressure, lipid control, glycemic control, and use of aspirin. Over the last 10 years, new randomized controlled trials (RCT) designed to study different blood pressure treatment targets did not find evidence that intensive systolic blood pressure control ( |
| doi_str_mv | 10.1111/jgs.12513 |
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The management of cardiovascular disease risk factors in older adults with DM is important to clinicians. The literature was reviewed from 2002 to 2012 to provide an American Geriatrics Society expert panel with an evidence base for updating and making new recommendations for improving the care of older adults with type 2 DM. This review includes only the domains of the management of blood pressure, lipid control, glycemic control, and use of aspirin. Over the last 10 years, new randomized controlled trials (RCT) designed to study different blood pressure treatment targets did not find evidence that intensive systolic blood pressure control (<130 mmHg) resulted in lower rates of myocardial infarction and mortality than less‐intensive control. There are risks of side effects with achieving systolic blood pressure of less than 120 mmHg. Lipid‐lowering statins are effective in reducing cardiovascular events in middle‐aged and older adults, but data on niacin and fibrates is limited. Trials of statins and other lipid‐lowering agents do not evaluate the cardiovascular effects on outcomes from treating lipids to different low‐density lipoprotein cholesterol targets. No RCTs of lipid‐lowering drugs enrolled significant numbers of adults aged 80 and older with or without DM. Three major RCTs that investigated intensive glycemic control did not find reductions in primary cardiovascular endpoints, and one study reported greater mortality with glycosylated hemoglobin of less than 6%. Two recently published RCTs were designed to study the cardiovascular benefits of aspirin use by individuals with DM. Neither trial found significantly fewer primary cardiovascular endpoints with aspirin than in control groups. Overall, RCTs enrolled few adults aged 80 and older or with significant comorbidities. More research is needed for clinicians to effectively customize care to older adults with DM because of heterogeneity in health status, comorbidities, duration of disease, frailty and functional status, and differences in life expectancy.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.12513</identifier><identifier>PMID: 24219205</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Hoboken, NJ: Blackwell Publishing Ltd</publisher><subject>Aged ; Aspirin ; Biological and medical sciences ; Biomedical Research ; Cardiovascular disease ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - prevention & control ; Diabetes ; Diabetes Complications - epidemiology ; Diabetes Complications - etiology ; Diabetes Complications - prevention & control ; diabetes mellitus ; Diabetes Mellitus, Type 2 - complications ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; General aspects ; Health care ; Humans ; Medical sciences ; Miscellaneous ; Older people ; Public health. Hygiene ; Public health. 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The management of cardiovascular disease risk factors in older adults with DM is important to clinicians. The literature was reviewed from 2002 to 2012 to provide an American Geriatrics Society expert panel with an evidence base for updating and making new recommendations for improving the care of older adults with type 2 DM. This review includes only the domains of the management of blood pressure, lipid control, glycemic control, and use of aspirin. Over the last 10 years, new randomized controlled trials (RCT) designed to study different blood pressure treatment targets did not find evidence that intensive systolic blood pressure control (<130 mmHg) resulted in lower rates of myocardial infarction and mortality than less‐intensive control. There are risks of side effects with achieving systolic blood pressure of less than 120 mmHg. Lipid‐lowering statins are effective in reducing cardiovascular events in middle‐aged and older adults, but data on niacin and fibrates is limited. Trials of statins and other lipid‐lowering agents do not evaluate the cardiovascular effects on outcomes from treating lipids to different low‐density lipoprotein cholesterol targets. No RCTs of lipid‐lowering drugs enrolled significant numbers of adults aged 80 and older with or without DM. Three major RCTs that investigated intensive glycemic control did not find reductions in primary cardiovascular endpoints, and one study reported greater mortality with glycosylated hemoglobin of less than 6%. Two recently published RCTs were designed to study the cardiovascular benefits of aspirin use by individuals with DM. Neither trial found significantly fewer primary cardiovascular endpoints with aspirin than in control groups. Overall, RCTs enrolled few adults aged 80 and older or with significant comorbidities. More research is needed for clinicians to effectively customize care to older adults with DM because of heterogeneity in health status, comorbidities, duration of disease, frailty and functional status, and differences in life expectancy.</description><subject>Aged</subject><subject>Aspirin</subject><subject>Biological and medical sciences</subject><subject>Biomedical Research</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Diabetes</subject><subject>Diabetes Complications - epidemiology</subject><subject>Diabetes Complications - etiology</subject><subject>Diabetes Complications - prevention & control</subject><subject>diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>General aspects</subject><subject>Health care</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Older people</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>review</subject><subject>Risk Factors</subject><subject>Risk Management</subject><subject>statin</subject><subject>Time Factors</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkl1v0zAUhiMEYmVwwR9AlhDSuMjmjzi2uUDaCiuglkkw2KXlJMeduzQpdtJSiR-PS7vyISGwZPnCz3lfn-M3SR4TfEziOplNwzGhnLA7yYBwRlOeEX43GWCMaSpzkh0kD0KYYUwolvJ-ckAzShTFfJB8m5jGTGEOTYdai4bGV65dmlD2tfHolQtgAqAPLtygc1N2rQ_INeiirsCj06qvu4BWrrtGl-sFIBoLTAEdBDSBunZdH14gunkEjdZo7Drwput9FISlg9XD5J41dYBHu_Mw-XT--nL4Jh1fjN4OT8dpyYVgacUpASILXAhTVlbhsrRVAaQShlDJrGSCGlEYrHBlWW6NlJxjIFBYZhUQdpi83Oou-mIOVRmb9abWC-_mxq91a5z-_aZx13raLjVTQmaERYGjnYBvv_QQOj13oYwtmgbaPmiSSxw3zfN_o5miOWVM_Q_KJcdCKhzRp3-gs7b3TRzahoofm2dUROr5lip9G4IHu2-RYL1Jio5J0T-SEtknv85kT95GIwLPdkBMg6mtN03pwk9OKJXlREXuZMutXA3rvzvqd6OPt9bptsKFDr7uK4y_0blgguur9yM9-TzCZ1dRZcS-A3Jm4qs</recordid><startdate>201311</startdate><enddate>201311</enddate><creator>Moreno, Gerardo</creator><creator>Mangione, Carol M.</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>5PM</scope></search><sort><creationdate>201311</creationdate><title>Management of Cardiovascular Disease Risk Factors in Older Adults with Type 2 Diabetes Mellitus: 2002-2012 Literature Review</title><author>Moreno, Gerardo ; Mangione, Carol M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5773-d521e18b0b7acdf90ccfdbe1d7a1283f8372a7ba090df36fa88550e1ebf3f9e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aspirin</topic><topic>Biological and medical sciences</topic><topic>Biomedical Research</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Diabetes</topic><topic>Diabetes Complications - epidemiology</topic><topic>Diabetes Complications - etiology</topic><topic>Diabetes Complications - prevention & control</topic><topic>diabetes mellitus</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>General aspects</topic><topic>Health care</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Older people</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>review</topic><topic>Risk Factors</topic><topic>Risk Management</topic><topic>statin</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moreno, Gerardo</creatorcontrib><creatorcontrib>Mangione, Carol M.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moreno, Gerardo</au><au>Mangione, Carol M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of Cardiovascular Disease Risk Factors in Older Adults with Type 2 Diabetes Mellitus: 2002-2012 Literature Review</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2013-11</date><risdate>2013</risdate><volume>61</volume><issue>11</issue><spage>2027</spage><epage>2037</epage><pages>2027-2037</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>Type 2 diabetes mellitus (DM) is one of the most common chronic conditions in older adults and is often accompanied by comorbidities and geriatric syndromes. The management of cardiovascular disease risk factors in older adults with DM is important to clinicians. The literature was reviewed from 2002 to 2012 to provide an American Geriatrics Society expert panel with an evidence base for updating and making new recommendations for improving the care of older adults with type 2 DM. This review includes only the domains of the management of blood pressure, lipid control, glycemic control, and use of aspirin. Over the last 10 years, new randomized controlled trials (RCT) designed to study different blood pressure treatment targets did not find evidence that intensive systolic blood pressure control (<130 mmHg) resulted in lower rates of myocardial infarction and mortality than less‐intensive control. There are risks of side effects with achieving systolic blood pressure of less than 120 mmHg. Lipid‐lowering statins are effective in reducing cardiovascular events in middle‐aged and older adults, but data on niacin and fibrates is limited. Trials of statins and other lipid‐lowering agents do not evaluate the cardiovascular effects on outcomes from treating lipids to different low‐density lipoprotein cholesterol targets. No RCTs of lipid‐lowering drugs enrolled significant numbers of adults aged 80 and older with or without DM. Three major RCTs that investigated intensive glycemic control did not find reductions in primary cardiovascular endpoints, and one study reported greater mortality with glycosylated hemoglobin of less than 6%. Two recently published RCTs were designed to study the cardiovascular benefits of aspirin use by individuals with DM. Neither trial found significantly fewer primary cardiovascular endpoints with aspirin than in control groups. Overall, RCTs enrolled few adults aged 80 and older or with significant comorbidities. More research is needed for clinicians to effectively customize care to older adults with DM because of heterogeneity in health status, comorbidities, duration of disease, frailty and functional status, and differences in life expectancy.</abstract><cop>Hoboken, NJ</cop><pub>Blackwell Publishing Ltd</pub><pmid>24219205</pmid><doi>10.1111/jgs.12513</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Aged Aspirin Biological and medical sciences Biomedical Research Cardiovascular disease Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology Cardiovascular Diseases - prevention & control Diabetes Diabetes Complications - epidemiology Diabetes Complications - etiology Diabetes Complications - prevention & control diabetes mellitus Diabetes Mellitus, Type 2 - complications Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance General aspects Health care Humans Medical sciences Miscellaneous Older people Public health. Hygiene Public health. Hygiene-occupational medicine review Risk Factors Risk Management statin Time Factors |
| title | Management of Cardiovascular Disease Risk Factors in Older Adults with Type 2 Diabetes Mellitus: 2002-2012 Literature Review |
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