If CAD can be identified in a preclinical stage, identifying patients with silent ischemia might lead to benefits beyond that from intensive risk factor reduction, perhaps leading to "more serious" risk factor treatment, both on the part of the physician and on the part of the patient, or, perhaps, to benefits beyond that from recommending revascularization.
Earlier onset of disease and higher levels of modifiable risk factors make early detection of diabetes, annual referral for retinal screening, and intensive risk factor control key elements in addressing this health inequality.
Open image in new window Fig. 1 Some scenarios for the energy demand of the year 2050 assuming a World population of 9.5 billion: Shell-Scenario „Sustainable Development"; three Scenarios of the Energy World Conferences WEC A3, WEC B and WEC C1; RIGES („Renewable Intensive Global Energy Scenario"); Factor 4 Scenario and SEE („Solar Energy Economy").
These findings highlight the potential for intensive risk factor modification to maximize CV event reduction in CKD patients at high risk for CHD.
In this randomized controlled trial, patients with the combination of type 2 diabetes and microalbuminuria, many also being hypertensive, were randomized to either intensive risk factor control or to standard therapy.
Patients with overt diabetes and hypertension are exposed to an exceptionally high risk of cardiovascular death, and are generally thought to need a more intensive risk factor control [ 1].
There is a paucity of clinical trial data specifically testing interventions in obese subgroups to determine whether more intensive risk factor management or obesity-specific treatment and control guidelines would result in decreased CVD outcomes.
We excluded patients if they had participated in intensive risk factor modification through a diabetes study in our clinic or if they had no cholesterol checks in the last 3 years, limiting our ability to provide current risk estimates.
The STENO-2 study was a trial investigating multifactorial interventions, targeting hypertension, hyperglycaemia and hyperlipidemia which impressively demonstrated the superiority of an intensive risk factor management as compared to a less intensive approach with respect to non-fatal and fatal cardiovascular event reduction [ 2, 16].
These findings suggest that increasing awareness of the beneficial effects of intensive risk factor control and inhibition of the renin-angiotensin system (10) might have led to improvement in the care standard and the reduced rate of clinical end points, at least in the Hong Kong setting.
