Recently, the American Heart Association (AHA) and the American Diabetes Association (ADA) jointly released a scientific statement on cardiovascular disease prevention in adults with type 2 diabetes to provide expert guidance on cardiovascular prevention in patients with type 2 diabetes.
This article summarizes the highlights of the scientific statement from the American College of Cardiology (ACC) website, written by Elizabeth A. Jackson from Michigan State University, Ann Arbor. 1. Cardiovascular disease is the most common cause of death in adults with diabetes, and glycosylated hemoglobin (HgA1c ≥ 6,5%) is recommended for the diagnosis and screening of diabetes. The focus of this statement is on the diagnosis and treatment of diabetic patients.
2. In addition to 2-hour glucose ≥ 200 mg/dl or fasting glucose ≥ 125 mg/dl for the diagnosis of diabetes, clinical practice currently recommends HgA1c ≥ 6,5% for the diagnosis of diabetes (no recommendation in China yet).
3. Lifestyle changes are central to the treatment of prediabetes and diabetes. Routine physical activity is associated with improvements in lipids and blood pressure and should be considered in combination with cardiovascular preventive medications such as statins. Strength exercise combined with aerobic exercise has the potential to improve glycemic control, but larger trials are needed to validate this.
Dietary patterns can influence overall diabetes control. Recommended dietary patterns include an emphasis on fruit and vegetable intake, reduced saturated fatty acids, and low-fat dairy products. Diabetes is associated with lower HDL cholesterol and higher triglycerides. The following approaches can significantly reduce blood lipids: changing the structure of the diet and increasing fruits and vegetables, reducing refined sugars, losing weight, and exercising regularly.
5. Weight management is a key issue in diabetes, and weight loss can improve blood glucose. Changes in dietary patterns and physical activity can reduce weight. Weight loss surgery, medication or reduction of medications that promote weight gain can be very useful for weight loss. Current. The American Heart Association/American College of Cardiology/Obesity Society guidelines recommend that adults with a BMI ≥ 35 kg/m2?and obesity-related comorbidities (such as diabetes) may consider weight loss surgery.
6. For adults with diabetes with a 10-year risk of cardiovascular disease ≥ 10%, the use of low-dose aspirin (75-162 mg/day) is reasonable. For adults with diabetes with a 10-year risk of cardiovascular disease between 5% and 10% (intermediate risk), aspirin is also reasonable.
Many studies have evaluated the goal of glycemic control. Based on this evidence, current guidelines recommend a reduced risk of microvascular disease with HgA1c ≤ 7,0% and fasting glucose <130 mg/dl). For patients with longer life expectancy and no significant cardiovascular disease, lower targets ( HgA1c ≤ 6,5%) may be considered. 8. The target blood pressure for patients with diabetes has been controversial, and guidelines recommend a blood pressure of <140/90 mm Hg for patients with diabetes. lower targets may be better for younger patients. Where possible, the recommended blood pressure control medication is an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. 9. Lipid management is important to reduce the risk of cardiovascular disease. Current guidelines recommend the use of intermediate-acting statins in patients with diabetes aged 40-75 years with an LDL of 70-89 mg/dl. For patients younger than 40 years or older than 75 years, clinicians should carefully evaluate the risks and benefits of statins. Treatment should be initiated at fasting triglycerides >500 mg/dl.
10. Renal disease is not uncommon in patients with diabetes. Urine microalbumin and glomerular filtration rate are recommended for monitoring renal function. Patients with combined diabetes and renal insufficiency are at increased risk of cardiovascular disease and renin angiotensin system blockers may be able to slow the progression of renal disease.