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Opportunities for improvement of cardiovascular risk management in patients with type 2 diabetes and chronic kidney disease

Integrated assessment of lifestyle habits and pharmacological intervention in routine clinical care
PhD ceremony:Ms C.M. (Christina) Gant
When:November 19, 2018
Start:16:15
Supervisors:prof. dr. G.J. (Gerjan) Navis, prof. dr. S.J.L. (Stephan) Bakker
Co-supervisor:dr. G.D. Laverman
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

Opportunities for improvement of cardiovascular risk management in patients with type 2 diabetes and chronic kidney disease: Integrated assessment of lifestyle habits and pharmacological intervention in routine clinical care

In the past decades there has been a significant rise in overweight and obesity, which is paralleled by an increasing number of patients with lifestyle-related diseases such as type 2 diabetes and chronic kidney disease. Followingly, cardiovascular risk management has become one of the most important parts of modern medicine. To prevent cardiovascular diseases, target values for blood pressure, cholesterol and glucose regulation have been formulated for daily practice. However, only a minority of patients reaches these target values. Although both lifestyle and pharmacological management are integral in reaching treatment targets, most research focuses on either lifestyle, or pharmacological management. We performed an integrated assessment of both lifestyle and pharmacological treatment in patients with type 2 diabetes. We demonstrated that targets for blood pressure, cholesterol and glucose regulation were achieved in 53%, 76% and 36% of cases respectively. For each target the opportunity for improving target achievement was different: while for cholesterol increasing pharmacological treatment was the best strategy, for blood pressure and glucose regulation lifestyle intervention was imperative due to growing treatment resistance for pharmacological agents. We also investigated how drugs that inhibit aldosterone might be used more effectively. We found that men, and patients with reduced renal function might have more benefit from such agents, because they have increased blood aldosterone levels. Our integrated approach provided unique insight in opportunities for improvement of cardiovascular risk management in a real-life setting. Therefore, we propose that monitoring of lifestyle habits should be added to routine care of lifestyle-related disease.