Panminerva medica
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Cardiac rehabilitation is very important since diabetes is the set of metabolic diseases characterized by chronic hyperglycemia, with alterations in the metabolism of carbohydrates, fats and proteins as a consequence of defects in the secretion and action of insulin. When diabetes is related to cardiovascular complications, they are the main cause of death due to risk factors such as dyslipidemia, obesity and hyperglycemia, thus causing atherosclerotic changes in the vascular bed, increasing the risk of a fulminant event. The prevention of heart disease in diabetics includes preventive methods of heart disease along with that of diabetes, such as glycemic control, proper nutrition, continuing therapeutic education, physical activity, and antilipid medications, along with pharmacological measures including vasodilators, beta-blockers and antiplatelet agents, etc. ⋯ Therapeutic management of heart disease in diabetic patients is aimed at reducing cardiovascular risk, through pharmacological and non-pharmacological treatments. However, the weakest point of the treatment is the lack of adherence to the treatments. Physical exercise is an essential element, together with hypoglycemic and nutritional treatment in diabetes mellitus (DM), due to its usefulness in the control of diabetes and prevention of cardiovascular complications.
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Review
Smoking cessation: strategies and effects in primary and secondary cardiovascular prevention.
Although smoking is seen as a major health problem by most clinicians, few are able to provide evidence based smoking cessation interventions to their patients. Most individuals who smoke actually want to quit. Unfortunately, smoking is still seen as a vice or lifestyle choice, when it is actually a chronic disease which often starts in adolescence. ⋯ Although classically tobacco dependence was seen in relation to smoking, since the early 2000s, new nicotine delivery systems have appeared on the market, which despite being marketed as "healthy" alternatives, can often complicate smoking cessation efforts and act as gateway devices for new generations of smokers. In this article we review the results of several large systematic reviews and meta-analyses, which have shown that many cessation strategies are effective. We also offer practical tips on providing brief cessation advice and how pharmacotherapy can be prescribed and incorporated into clinical practice in both primary and secondary cardiovascular prevention.
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Review
Sleep apnoea, the ugly duckling of the Cinderellas in cardiovascular prevention and rehabilitation.
Cardiovascular diseases are the leading cause of death and account for the largest share of health expenditure worldwide, mainly invested in hospital and secondary care. Prevention and rehabilitation strategies are nearly neglected, therefore "the Cinderellas," in the health-care budget. The World Health Organization has proposed cost-effective interventions to reduce the impact of cardiovascular diseases that include polydrug treatment for hypertension and diabetes, counselling, diet, exercise, and others. ⋯ If obstructive sleep apnea plays a significant role in cardiovascular diseases, then screening and timely appropriate treatment could reduce morbidity and mortality. Thus, the public health and economic impact of these conditions could be included in the "best buy" list of interventions. This narrative review discusses the relationship between OSA and cardiovascular diseases and how neglected the link is.