R E V I E W A critical dialogue: communicating with type 2 diabetes patients about cardiovascular risk Paris Roach David Marrero Department of Medicine, Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, IN, USA Correspondence: Paris Roach Department of Medicine, Indiana University School of Medicine, 545 Barnhill Drive, EH 421, Indianapolis, IN 46202, USA Tel +1 317 274 5696 Fax +1 317 274 4311 Email paroach@iupui.edu Abstract: Patients with type 2 diabetes mellitus (DM) are at increased risk for cardiovascular disease (CVD), and many patients are inadequately treated for risk factors such as hyperglycemia, hyperlipidemia, hypertension, and smoking. Providing individualized risk information in a clear and engaging manner may serve to encourage both patients and their physicians to intensify risk-reducing behaviors and therapies. This review outlines simple and effective methods for making CVD risk infomation understandable to persons of all levels of literacy and mathematical ability. To allow the patient to understand what might happen and how, personal risk factors should be clearly communicated and the potential consequences of a CVD event should be presented in a graphic but factual manner. Risk calculation software can provide CVD risk estimates, and the resulting information can be made understandable by assigning risk severity (eg, “high”) by comparing clinical parameters with accepted treatment targets and by comparing the individual’s risk with that of the “average” person. Patients must also be informed about how they might reduce their CVD risk and be supported in these efforts. Thoughtful risk communication using these techniques can improve access to health information for individuals of low literacy, especially when interactive computer technology is employed. Research is needed to find the best methods for communicating risk in daily clinical practice. Keywords: cardiovascular disease, type 2 diabetes, cardiovascular risk, risk communication Introduction Cardiovascular disease (CVD), broadly defined as stroke, coronary artery disease, and peripheral vascular disease is the major cause of morbidity and mortality in persons with type 2 diabetes mellitus (DM). Up to 80% of persons with diabetes will develop CVD, and half to two-thirds of all deaths associated with DM are due to CVD, primarily ischemic heart disease (Meigs et al 1997; Mooradian et al 2003). Nearly 80% of hospitalizations in the US for chronic complications of diabetes are attributable to CVD, and the costs associated with macrovascular disease are ten times greater than those for microvascular disease (Mooradian et al 2003; Vijan et al 2004). While hyperglycemia is the most prominent abnormality in DM, hypertension and hyperlipidemia are more common and have a greater impact on CVD risk in people with DM than in nondiabetic individuals (Sowers and Haffner 2002). Despite the magnitude of this problem and the fact that safe and effective therapies are widely available, most patients are inadequately treated for CVD risk factors (Phillips et al 2001). While the factors leading to this undertreatment are many and complex, several commonly encountered physician and patient factors may be amenable to intervention. From the physician’s perspective, hypertension, hyperlipidemia, cigarette smoking, and aspirin therapy are often given less attention than hyperglycemia in patients with diabetes, but may be of equal or greater importance with respect to reducing CVD Vascular Health and Risk Management 2005:1(4) 301–307 © 2005 Dove Medical Press Limited. All rights reserved 301