Despite adverse weather conditions – there was a good attendance at the first HVD congress and Bayer symposium in Lisbon

The first 'Heart, Vessels & Diabetes European Conference' (Lisbon, Portugal, 9-11 December, 2010) gave Bayer Schering Pharma the opportunity to illustrate the commitment of the company in cardiovascular medicine. The Bayer-sponsored symposium 'Managing CV risk factors for disease prevention', which was held during the congress was also well-received, being attended by nearly 200 delegates.

The meeting was chaired by Professor Standl from the Munich Diabetes Research Group/Diabetes Research Institute, Munich, Germany, and its primary aim was to consider how to protect more patients from cardiovascular disease, with the main focus being on the key risk factors – diabetes and hypertension. Additional key objectives were to digest the latest hypertension trials, particularly the impact of TALENT and to discuss the latest findings in anti-diabetic and anti-thrombotic research. Based on the Q&A session, the audience were particularly interested in the role and treatment of testosterone deficiency in obese diabetic men – currently an over-looked risk factor in this patient group.

Professor Morais (Chief of Cardiology Division of Santo Andre's Hospital, Leiria, Portugal) opened the symposium with a discussion on the cardioprotective properties of antihypertensive agents. In 2009, the ESH Task Force acknowledged that there is a progressive reduction of cardiovascular events when systolic and diastolic blood pressures are lowered to around 120 mmHg and 75 mmHg, respectively. While all major antihypertensive drugs do not differ in their ability to reduce blood pressure – they do differ in their ability to protect against cardiovascular risk.

Pritor/Kinzal^® is one of the first antihypertensive agents to have its label extended beyond blood-pressure control based on the cardioprotective benefits observed in the ONTARGET^TM, PROTECTION^TM, and PRoFESS^® programmes. In the EU, Pritor/Kinzal^® is now indicated for the reduction of cardiovascular morbidity in patients with manifest atherothrombotic cardiovascular disease (history of coronary artery disease, stroke, transient ischaemic attack, or peripheral artery disease) or type 2 diabetes mellitus with documented target organ damage.

Pritor/Kinzal^® also hit the headlines this year due to the exciting results of the TALENT study. Professor Ruilope from the Complutense University and Octubre Hospital, Madrid, Spain, one of the study’s Investigators, gave an overview of the TALENT findings. The study enrolled high-risk patients to initial therapy with Adalat^® GITS /Pritor/Kinzal^® or a stepped-care approach with these agents. "Initiating antihypertensive treatment with the combination of Adalat^® GITS/Pritor/Kinzal^® allowed blood pressure control to be achieved earlier compared with starting with one drug and then adding a second. Optimum blood pressure reduction was achieved as early as two weeks and was maintained throughout the 24-week study." Professor Ruilope, Spain. TALENT has shown that target blood pressure can be achieved more quickly by starting with combination therapy than a stepped-care approach. Adalat^® GITS/Pritor/Kinzal® may be optimal as initial therapy in all hypertensive patients (clinic blood pressure >150/90 mmHg) who are overweight, have elevated lipids or glucose or previous events.

The management of the diabetic patient is challenging, but is must be remembered that Acarbose is well-established in reducing the risk of cardiovascular events and hypertension, and should be considered a key treatment was the take-home message from Professor Ceriello (Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain). During his presentation, Professor Ceriello also presented exciting new findings on the inhibitory effects of Acarbose on advanced glycation end-products (AGEs) in patients with diabetes, which are associated with cardiovascular and total mortality (further reading on this topic: Tsunosue M, et al. Clin Exp Med 2010;10:139-141). The role of aspirin in the diabetic patient was also reviewed by Doctor Mellbin (Karolinska University Hospital, Stockholm, Sweden) who presented ‘for and against’ arguments for its use. The arguments in favour of aspirin therapy mainly relate to the high risk of cardiovascular events in these patients (diabetes is regarded by some as a CHD-equivalent), meta-analyses such as those produced by the ATTC (2009) show a modest benefit in these patients and the lack of optimal control of cardiovascular disease in general practices. However, it must also be noted that the trends for a benefit in meta-analyses are not statistically significant, and platelet turnover in diabetes may necessitate the need for a different dosing strategy.

Based on the latest trial data, including the findings from the most recent meta-analyses, the ACC/ADA/AHA (2010) guidelines and the US Prevention Task Force (2009) recommend that aspirin (75–162 mg/day) should be considered for adults with diabetes and no previous history of CVD who are at increased cardiovascular risk (10-year risk >10%) but have no increased risk for bleeding.

Testosterone treatment in diabetic men with testosterone deficiency may be an interesting new approach to improving body composition and glycaemic control in these patients. In his presentation on this emerging area, Professor Saad (Bayer Schering Pharma AG, Berlin, Germany; Gulf Medical College, Ajman, United Arab Emirates and Hang Tuah University, Surabaya, Indonesia) described the epidemiological studies showing associations between testosterone deficiency and type 2 diabetes, and the predictive value of testosterone in the development of insulin resistance and type 2 diabetes. Intervention studies such as the DIMALITE study have shown that treatment with testosterone gel (Testogel^®) was associated with a greater improvement of visceral obesity, insulin sensitivity and glycaemic control compared with lifestyle-only changes in men with newly-diagnosed diabetes. In a placebo-controlled study using injections of testosterone undecanoate (Nebido^®), body fat was reduced by up to 19.2% with a parallel substantial increase in lean mass and a significant improvement of HOMA-IR (Aversa A et al. J Sex Med 2010; 7(10): 3495-3503).