Therapeutic goals in patients with diabetes without cardiovascular events

Abstract

Defining therapeutic goals in people with type 2 diabetes mellitus (T2DM) without clinical cardiovascular disease remains one of the main challenges in clinical practice. While current recommendations promote individualized treatment based on overall cardiovascular risk, the increasing availability of tools capable of identifying subclinical atherosclerotic disease prompts a rethinking of the traditional concepts of risk and primary prevention.

The detection of subclinical atherosclerosis, chronic kidney disease, and other cardiovascular risk modifiers, along with emerging markers such as residual inflammation, can modify the intensity of therapeutic goals and the selection of hypoglycemic treatment, even in the absence of overt cardiovascular events. Using a clinical case, we will discuss how these findings can redefine the targets for LDL cholesterol, glycemic control, weight loss, and cardiorenal protection, integrating the evidence provided by the ADA, EASD, ESC, and KDIGO guidelines.

The aim of this dissertation is to reflect on a paradigm shift: in diabetes mellitus (DM), the absence of cardiovascular events does not always equate to the absence of cardiovascular disease. Early recognition of the burden of subclinical disease allows for individualized therapeutic goals and the intensification of prevention strategies before the first clinical event occurs.

The first event does not mark the onset of cardiovascular disease; it simply marks the point at which we cease to call it subclinical.