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    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "High prevalence of cardiovascular disease and risk factors among type 2 diabetes patients followed in a hospital setting in Portugal"
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        "titulo" => "Alta preval&#234;ncia de doen&#231;as cardiovasculares e fatores de risco entre pacientes com diabetes tipo 2 acompanhados em ambiente hospitalar em Portugal"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the article &#8220;High prevalence of cardiovascular disease and risk factors among type 2 diabetes patients followed in a hospital setting in Portugal&#8221; by Cardoso et al&#46; with profound interest and enthusiasm&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> We were fortunate to have the opportunity to read this manuscript&#44; and the diligent efforts of the authors are deserving of admiration&#46; We agree with their conclusion that there is a higher prevalence of cardiovascular &#40;CV&#41; disease and CV risk factors among cohorts of Portuguese type 2 diabetes patients being followed in a hospital setting&#46; However&#44; it is vital to consider additional points that would enhance the quality of this article and contribute to the existing body of knowledge&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Firstly&#44; the retrospective nature of the study is of significant concern due to the risk of reporting bias and imprecise substantiation&#46; For further clarification&#44; a 2017 study conducted by Yang et al&#46; had 20&#46;2 months&#8217; follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The depth and dependability of their conclusions were increased by the longer follow-up period&#44; which also provided more thorough knowledge of long-term patterns&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">With all due respect&#44; the authors should have taken a larger population to signify the results of the study&#46; Likewise&#44; other articles mentioned a much larger population to supplement the results&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#8211;5</span></a> This can remove cognitive bias from the study&#59; and larger studies provide stronger and more reliable results because they have smaller margins of error and lower standards of deviation&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors did also not mention the intake of certain anti-diabetic drugs&#44; such as meglitinides&#44; a novel class of non-sulfonylurea insulin secretagogues with a very rapid onset and abbreviated duration of action and&#44; an oral anti-diabetic from the thiazolidinedione drug class that decreases insulin resistance in the periphery and in the liver&#46; This results in increased insulin-dependent glucose disposal and decreased hepatic glucose output&#46; These drugs were taken by the participants of another study and may have affected the results&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">By explaining the diagnostics of the participants and mentioning participants with serious liver&#44; lung&#44; kidney disorder and other organ dysfunction in the exclusion criteria&#44; the authors could widen exclusion criteria to avoid potential bias and make the results clearer since these conditions do have an effect on cardiovascular health&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> This would not only strengthens the internal validity of the study&#44; but also provide a comprehensive understanding of and relationship between cardiovascular health and diabetes&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; as it is widely known that type 2 diabetes mellitus has an adverse effect on cardiovascular health and increases the risk of cardiovascular disease&#44; the authors should have explained the same outcome on other age groups&#44; which would have made the study more s and applicable&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although this study offers insightful information about the connection between type 2 diabetes mellitus and cardiovascular health&#44; there are several noteworthy areas where its applicability might be improved&#46; Further research in this area can build on the groundwork established by this study by considering the areas of weakness I have mentioned in my critique&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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