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European Heart Journal 2007 28(1):88-136; doi:10.1093/eurheartj/ehl260
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© 2007 The European Society of Cardiology and European Association for the Study of Diabetes (EASD). All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

{dagger}Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary,

The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)

Authors/Task Force Members, Lars Rydén, Co-Chairperson*, Eberhard Standl, Co-Chairperson*, Malgorzata Bartnik, Greet Van den Berghe, John Betteridge, Menko-Jan de Boer, Francesco Cosentino, Bengt Jönsson, Markku Laakso, Klas Malmberg, Silvia Priori, Jan Östergren, Jaakko Tuomilehto and Inga Thrainsdottir

Sweden
Germany
Poland
Belgium
UK
The Netherlands
Italy
Sweden
Finland
Sweden
Italy
Sweden
Finland
Iceland

Other Contributors, Ilse Vanhorebeek, Marco Stramba-Badiale, Peter Lindgren and Qing Qiao

Belgium
Italy
Sweden
Finland

ESC Committee for Practice Guidelines (CPG), Silvia G. Priori, Chairperson, Jean-Jacques Blanc, Andrzej Budaj, John Camm, Veronica Dean, Jaap Deckers, Kenneth Dickstein, John Lekakis, Keith McGregor, Marco Metra, João Morais, Ady Osterspey, Juan Tamargo and José Luis Zamorano

Italy
France
Poland
UK
France
The Netherlands
Norway
Greece
France
Italy
Portugal
Germany
Spain
Spain

Document Reviewers, Jaap W. Deckers, CPG Review Coordinator, Michel Bertrand, Bernard Charbonnel, Erland Erdmann, Ele Ferrannini, Allan Flyvbjerg, Helmut Gohlke, Jose Ramon Gonzalez Juanatey, Ian Graham, Pedro Filipe Monteiro, Klaus Parhofer, Kalevi Pyörälä, Itamar Raz, Guntram Schernthaner, Massimo Volpe and David Wood

The Netherlands
France
France
Germany
Italy
Denmark
Germany
Spain
Ireland
Portugal
Germany
Finland
Israel
Austria
Italy
UK

* Corresponding author. Lars Rydén, Department of Cardiology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. Tel: +49 89 3068 2523; Fax: +49 89 3068 3906. Eberhard Standl, Department of Endocrinology, Munich Schwabing Hospital, D-80804 Munich, Germany. Tel: +49 89 3068 2523; Fax: +49 89 3068 3906. E-mail address: lars.ryden@ki.se; eberhard.standl@lrz.uni_muenchen.de

The first 150 words of the full text of this article appear below.


    Preamble
 
Guidelines and Expert Consensus documents aim to present management and recommendations based on all of the relevant evidence on a particular subject in order to help physicians to select the best possible management strategies for the individual patient, suffering from a specific condition, taking into account not only the impact on outcome, but also the risk benefit ratio of a particular diagnostic or therapeutic procedure. The ESC recommendations for guidelines production can be found on the ESC website{dagger}.

In brief, the ESC appoints experts in the field to carry out a comprehensive and critical evaluation of the use of diagnostic and therapeutic procedures and to assess the risk–benefit ratio of the therapies recommended for management and/or prevention of a given condition. The strength of evidence for or against particular procedures or treatments is weighed according to predefined scales for grading recommendations and levels of evidence, as outlined below. Once . . . [Full Text of this Article]


    Introduction
 

    Definition, classification, and screening of diabetes and pre-diabetic glucose abnormalities
 
Definition and classification of diabetes
Glycated haemoglobin
Markers of glucometabolic perturbations
Comparisons between FPG and 2 h post-load glucose
Screening for undiagnosed diabetes
Detection of people at high risk for diabetes

    Epidemiology of diabetes, IGH, and cardiovascular risk
 
Prevalence of disease categories and age
Plasma glucose age and gender
Prevalence of diabetes and IGH
Diabetes and coronary artery disease
IGH and CAD
Cardiovascular risk and post-prandial hyperglycaemia
Glycaemic control and cardiovascular risk
Gender difference in CAD related to diabetes
Glucose homeostasis and cerebrovascular disease
Diabetes and stroke
IGT and stroke
Prevention of CVD in people with IGH

    Identification of subjects at high risk for CVD or diabetes
 
Metabolic syndrome
Definitions
Risk charts
Preventing progression to diabetes
Prevention of CVD by physical activity

    Treatment to reduce cardiovascular risk
 
Lifestyle and comprehensive management
Glycaemic control
Relation to microangiopathy and neuropathy
Relation to macroangiopathy
Relationship with acute coronary syndromes
Current treatment approach to glycaemic control
Dyslipidaemia
Background and epidemiology
Dyslipidaemia and vascular risk
Treatment benefits of statin therapy
Secondary prevention
Goals of therapy for secondary prevention
Primary prevention
Goals of therapy for primary prevention
Fibrate trials
Guidelines for HDL cholesterol and triglycerides
Blood pressure
Background
Treatment targets
How should blood pressure be lowered?

    Management of CVD
 
Coronary artery disease
Epidemiology
Diabetes and ACS
Prognostic implications
Treatment principles
Risk stratification
Treatment targets
Specific treatment
Thrombolysis
Early revascularization
Anti-ischaemic medication
Beta-blockade
Other drugs
Anti-platelet and anti-thrombotic agents
ACE-inhibitors
Lipid-lowering drugs
Metabolic support and control
Diabetes and coronary revascularization
Surgery vs. percutaneous intervention
Adjunctive therapy
Revascularization and reperfusion in MI
Unresolved issues

    Heart failure and diabetes
 
Epidemiological aspects
Prevalence of heart failure and glucose abnormalities
Incidence of heart failure and glucose abnormalities
Prognostic implications
Treatment
ACE-inhibitors
Angiotensin-II receptor blockers
Beta-blockers
Diuretics
Aldosterone antagonists
Glucose-lowering treatment and metabolic modulation
Insulin
Thiazolidinediones
Metabolic modulators

    Arrhythmias: atrial fibrillation and sudden cardiac death
 
Diabetes, atrial fibrillation, and risk of stroke
Diabetes and atrial fibrillation
Diabetes and risk of stroke in atrial fibrillation
Antithrombotic therapy in atrial fibrillation
Diabetes and stroke risk stratification schemes
Antithrombotic therapy in diabetic patients
Sudden cardiac death
Epidemiology of sudden cardiac death in diabetes
Pathophysiology of sudden cardiac death in diabetes

    Peripheral and cerebrovascular disease
 
Peripheral vascular disease
Background
Diagnosis
Treatment
General measures and platelet inhibition
Revascularization
Medical treatment of critical limb ischaemia
Stroke
Background
Prevention of stroke
Treatment of acute stroke

    Intensive care
 
Hyperglycaemia and outcome of critical illness
Blood glucose control with intensive insulin therapy in critical illness
Mechanisms behind improved outcome with intensive insulin

    Health economics and diabetes
 
Cost-of-illness studies
The cost of complications
Cost-effectiveness of intervention

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Eur Heart JHome page
A. Nicolucci, G. De Berardis, M. Sacco, and G. Tognoni
AHA/ADA vs. ESC/EASD recommendations on aspirin as a primary prevention strategy in people with diabetes: how the same data generate divergent conclusions
Eur. Heart J., August 2, 2007; 28(16): 1925 - 1927.
[Abstract] [Full Text] [PDF]


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British Journal of Diabetes & Vascular DiseaseHome page
G. Matfin
Aspects of drug development and clinical trials -- Part 2
The British Journal of Diabetes & Vascular Disease, July 1, 2007; 7(4): 149 - 150.
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British Journal of Diabetes & Vascular DiseaseHome page
G. Matfin
Review: Challenges in developing therapies for the metabolic syndrome
The British Journal of Diabetes & Vascular Disease, July 1, 2007; 7(4): 152 - 156.
[Abstract] [PDF]


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Eur Heart JHome page
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al.
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660.
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Eur Heart JHome page
Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al.
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Eur. Heart J., June 11, 2007; (2007) ehm236v1.
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Diabetes and Vascular Disease ResearchHome page
R. E Anderson, K. Brismar, and T. Ivert
Only a minority of patients referred for elective coronary artery bypass surgery have risk factors diagnosed and treated according to established guidelines
Diabetes and Vascular Disease Research, June 1, 2007; 4(2): 112 - 116.
[Abstract] [PDF]


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Eur Heart JHome page
A. J. Scheen and L. F. Van Gaal
Rimonabant as an adjunct therapy in overweight/obese patients with type 2 diabetes
Eur. Heart J., June 1, 2007; 28(11): 1401 - 1402.
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British Journal of Diabetes & Vascular DiseaseHome page
G. Matfin
Aspects of drug development and clinical trials -- Part 1
The British Journal of Diabetes & Vascular Disease, May 1, 2007; 7(3): 97 - 98.
[PDF]


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British Journal of Diabetes & Vascular DiseaseHome page
G. Matfin
Review: Biomarkers in clinical trials and drug development: measurement of cardiometabolic risk
The British Journal of Diabetes & Vascular Disease, May 1, 2007; 7(3): 101 - 106.
[Abstract] [PDF]


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British Journal of Diabetes & Vascular DiseaseHome page
R. E Pratley and G. Matfin
Review: Pre-diabetes: clinical relevance and therapeutic approach
The British Journal of Diabetes & Vascular Disease, May 1, 2007; 7(3): 120 - 129.
[Abstract] [PDF]


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Diabetes and Vascular Disease ResearchHome page
C. J Bailey and K G. M. Alberti
Cardio-diabetes alliances
Diabetes and Vascular Disease Research, March 1, 2007; 4(1): 5 - 6.
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British Journal of Diabetes & Vascular DiseaseHome page
C. Day
Cardio-diabetes: new ESC-EASD joint guidelines
The British Journal of Diabetes & Vascular Disease, March 1, 2007; 7(2): 47 - 48.
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Diabetes and Vascular Disease ResearchHome page
C. Day
Metabolic syndrome, or What you will: definitions and epidemiology
Diabetes and Vascular Disease Research, March 1, 2007; 4(1): 32 - 38.
[Abstract] [PDF]