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Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Detection of people at high risk for HF (stage A) or those with stage B HF (without symptoms but with either structural/ functional cardiac abnormalities or elevated biomarkers natriuretic peptides or troponin) would permit earlier implementation of effective strategies to prevent or delay the progression to advanced HF in individuals with diabetes
Indians are at very high risk of developing Atherosclerotic Cardiovascular disease (ASCVD), they usually get the disease at an early age, have a more severe form of the disease and have poorer outcome as compared to the western populations. This is due to high prevalence of Atherogenic dyslipidemia, central abdominal adiposity & increased transfats in our diet. Among the various risk factors for ASCVD such as dyslipidemia, Diabetes mellitus, sedentary lifestyle, Hypertension, smoking, genetic predisposition etc., dyslipidemia has the highest population attributable risk for MI. Hence monitoring lipid profile regularly for effective management of dyslipidemia remains one of the most important healthcare targets for prevention of ASCVD. This monitoring should start as early as 20 years of age. Lipid association of India (LAI 2020) has categorized individuals into Low risk, Moderate risk, High risk, Very high risk & Extreme risk on the basis of their LDL-C, Non-HDL-C & ApoB blood levels. Use of lipid lowering drugs particularly statins has reduced ASCVD morbidity and mortality; however significant residual risk for the events remains. Additional testing for inflammatory (HsCRP), non-lipid (Homocysteine) and other lipid biomarkers (Apo A, Apo B & Lp(a) ) may be considered for risk refinement. Presence of one or more secondary risk factor should prompt the clinician to consider drug therapy for patient whose atherogenic cholesterol level is higher than goal level.
Cardiometabolic syndrome represent a cluster of interrelated risk factors, primarily hypertension, elevated fasting blood sugar, dyslipidemia, abdominal obesity and elevated triglycerides. Cardiometabolic health has emerged as a concern due to increasing trend in development of Obesity and Metabolic syndrome which are independent risk factors for Cardiovascular Diseases and other complications. The two most important risk factors defined by National Heart, Lung and Blood Institute are Central obesity and Insulin resistance. Other risk factors include age, family history, lack of exercise and Polycystic Ovarian Syndrome. Metabolic syndrome increases the risk of development of Type 2 Diabetes Mellitus, Cardiovascular complications like Atherosclerosis, Peripheral Vascular Disease, Heart attack, Stroke as well as Non Alcoholic Fatty Liver Disease (NAFLD). The syndrome is typically asymptomatic thus it is recommended to measure additional biomarkers associated with insulin resistance.