Diabetics Need Careful Management of Cardiovascular Disease and Risk, Groups Says
By Will Boggs MD
NEW YORK (Reuters Health) - The American Diabetes Association (ADA) Standards of Medical Care and Diabetes 2018 offers a range of recommendations for cardiovascular disease and risk management in nonpregnant adults with diabetes.
ADA recommends that cardiovascular risk factors be assessed at least annually in all patients with diabetes, Dr. Eric L. Johnson from the University of North Dakota School of Medicine, in Grand Forks, and colleagues note in Annals of Internal Medicine, online April 3.
"We always need to remember that adults with diabetes have high ASCVD risk, and we have opportunities to reduce well-understood risk factors like lipids, blood pressure, and lifestyle. The addition of ASCVD benefit from certain antihyperglycemics is a very important newer recommendation," Dr. Johnson told Reuters Health by email.
"Always consider the needs of the patient in front of you when making treatment decisions involving the intensity of treatment for hyperglycemia, blood pressure, lipids, and lifestyle," he said. "Assess risk, expected lifespan, co-morbid conditions or complications, lifestyle and psychosocial factors, such as cost, complexity of treatment regimen, and ability to manage a regimen, in creating a treatment plan for a given patient."
More than two dozen recommendations in the new standards address diagnosis and treatment of hypertension and dyslipidemia, aspirin use, screening for and treatment of coronary heart disease as well as lifestyle interventions.
Patients with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mm Hg and a diastolic blood pressure goal of <90 mm Hg, and lower targets might be appropriate for individuals at high risk of cardiovascular disease.
All patients with diabetes and atherosclerotic cardiovascular disease (ASCVD) should receive high-intensity statin therapy, whereas moderate-intensity statins should be considered for patients under 40 years with additional ASCVD risk factors and for patients 40 years and older without ASCVD.
The standards recommend aspirin therapy as primary prevention for individuals with diabetes who are at increased cardiovascular risk and as secondary prevention in those diabetics with a history of ASCVD.
Routine screening for coronary artery disease is not recommended for asymptomatic patients, but investigations might be considered in the presence of atypical cardiac symptoms, signs or symptoms of associated vascular disease, or ECG abnormalities.
Patients with ASCVD can benefit not only from standard cardiovascular treatments, but also from antihyperglycemic medications proven to reduce major adverse cardiovascular events and cardiovascular mortality, such as empagliflozin and liraglutide.
The standards stress the importance of lifestyle interventions, including weight loss, increased physical activity, medical nutrition therapy and smoking cessation.
Ann Intern Med 2018.
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