Dr Nikolaus Marx Highlights Importance of Early Screening for Comorbid Diabetes, CVD

Nikolaus Marx, MD, professor of medicine/cardiology and head of the department of internal medicine, University Hospital Aachen, Germany, explains the new European Society of Cardiology (ESC) guidelines on screening for patients with diabetes and comorbid cardiovascular disease (CVD), which were presented at ESC Congress 2023.

Transcript

Can you elaborate on the rationale behind the newly-recommended systematic screening for patients with diabetes and comorbid CVD?

Patients with diabetes exhibit an increased risk to develop cardiovascular disease, and there’s a high incidence of undetected diabetes in patients that we see in our cardiology departments. Since we now have treatment options for patients with diabetes—type 2 diabetes in particular—to reduce cardiovascular risk, it’s very important to screen our patients to identify them as early as possible to allow and to make it possible to introduce these cardiovascular risk-reducing therapies.

Why is it important to annually screen for chronic kidney disease among patients with type 2 diabetes?

In addition to cardiovascular disease, patients with diabetes often develop chronic kidney disease [CKD], and the presence of chronic kidney disease has an impact on the prognosis and CKD is a driver for the development of cardiovascular disease by itself. Therefore, it is important to evaluate patients not only for cardiovascular disease, but for the presence of target organ damage, in particular chronic kidney disease. And therefore, we recommend that they are regularly screened for the presence of CKD using eGFR and urine albumin creatinine ratio in the spot urine, so an easy tool to measure it. Because, if we have a patient with type 2 diabetes and chronic kidney disease, we have new treatment options, for example, SGLT2 inhibitor finerenone, agents that have been shown in cardiovascular outcome trials to reduce cardiovascular but also kidney failure risk.

What key components are considered in the SCORE2-Diabetes scoring system?

It is important in patients without ASCVD [atherosclerotic CVD] and severe target organ damage to quantify their risk and do a risk stratification. And there were different scores, but they had difficulties not covering various aspects. So we introduced a new score—SCORE2-Diabetes—which had the original components of the very well-established SCORE2, which had age, smoking, and many other components [like] blood pressure lipids, and in addition, diabetes-specific components [such as] duration of diabetes, HbA1c, and eGFR. And this score is a specific score for patients with type 2 diabetes to predict the 10-year risk of a cardiovascular event, fatal or nonfatal MI [myocardial infarction], or stroke.