Moving from the stratification of primary and secondary prevention of cardiovascular risk in diabetes towards a continuum of risk: need for a new paradigm

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Abstract

Traditionally, patients with type 2 diabetes have been stratified according to cardiovascular (CV) risk to requiring either primary prevention (those without atherosclerotic CV disease) or secondary prevention (those with atherosclerotic CV disease in any of the vascular beds). However, this classification is misleading and arbitrary, as not all patients requiring secondary prevention have the same risk for such events, which also holds true for those requiring primary prevention (i.e. CV risk ranges from moderate to very high). In addition, in some cases, the definitions of primary and secondary prevention do not rely on symptoms but rather on the results of supplementary tests. Furthermore, patients with type 2 diabetes may also develop heart failure or chronic kidney disease. Importantly, reducing CV risk stratification to primary and secondary prevention does not provide a comprehensive approach for the management of patients with diabetes, leading to an underuse of drugs with proven CV benefit regardless of the presence of atherosclerotic CV disease. Therefore, patients with diabetes should be treated according to their CV risk considered as a continuum and not simply as falling within primary or secondary prevention.

Keywords: acute cardiovascular event, cardiovascular risk, diabetes, secondary prevention.

Citation: Garcia-Moll X, Barrios V, Franch-Nadal J. Moving from the stratification of primary and secondary prevention of cardiovascular risk in diabetes towards a continuum of risk: need for a new paradigm. Drugs Context. 2021;10:2021-6-3. https://doi.org/10.7573/dic.2021-6-3

Contributions: All authors have participated in drafting, reviewing, and/or revising the manuscript and have approved its submission. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: XGM declares no conflict of interest regarding the subject of the manuscript. VB declares no conflict of interest regarding the subject of the manuscript. JF declares no conflict of interest regarding the subject of the manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2021/07/dic.2021-6-3-COI.pdf

Acknowledgements: Editorial assistance was provided by Content Ed Net, Madrid, Spain.

Funding declaration: Editorial assistance was funded by Boehringer Ingelheim and Lilly Alliance.

Copyright: Copyright © 2021 Garcia-Moll X, Barrios V, Franch-Nadal J. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Garcia-Moll X, Barrios V, Franch-Nadal J. https://doi.org/10.7573/dic.2021-6-3. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/moving-from-the-stratification-of-primary-and-secondary-prevention-of-cardiovascular-risk-in-diabetes-towards-a-continuum-of-risk:-need-for-a-new-paradigm

Correspondence: Xavier Garcia-Moll, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Email: xgarcia-moll@santpau.cat

Provenance: Submitted; externally peer reviewed.

Submitted: 11 June 2021; Accepted: 13 July 2021; Publication date: 18 August 2021.

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