Cardiovascular risk management in patients with type 2 diabetes, AHA releases latest scientific statement

Cardiovascular disease is the leading cause of death and disability in people with diabetes
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Evidence-based therapy to control or improve multiple cardiometabolic abnormalities in patients with type 2 diabetes (T2D) can significantly reduce the risk of cardiovascular events
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In recent years, a number of important clinical studies have been published on cardiovascular risk management in adults with type 2 diabetes, covering life>
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On January 10, the American Heart Association (AHA) published an updated scientific statement on cardiovascular risk factor management in patients with type 2 diabetes in Circulation, emphasizing patient-centered life>
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This scientific statement focuses on updating: (1) the evidence and clinical utility of novel hypoglycemic agents in improving glycemic control and reducing cardiovascular events in patients with diabetes; (2) the effect of blood pressure control on cardiovascular events in diabetes; (3) novel hypoglycemic agents The role of lipotherapy in cardiovascular risk management in adult diabetic patients
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Figure 1: Reducing Cardiovascular Risk in Adults with Type 2 Diabetes: Core Graphical Life>
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In addition, there is an important relationship between glycemic control and accompanying depression, stress, and anxiety
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Therefore, patient-centered, culturally appropriate advice through diabetes self-management education and support and medical nutrition therapy is key to achieving personalized goals for behavioral change and diabetes self-management
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Glycemic goals and antidiabetic drugs American Diabetes Association (ADA) guidelines recommend that glycated hemoglobin (A1c) control goals should follow a patient-centered individualized principle: most non-pregnant adult patients, target A1c<7% (53mmol/mol); For patients with young age, long life expectancy, and no significant cardiovascular disease, target A1c<6.
5%; for patients with a history of severe hypoglycemia, limited life expectancy, and advanced microvascular or macrovascular complications, the target can be appropriately relaxed (eg, A1c<8%) )
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In ADA guidelines, metformin is first-line therapy
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In patients with established atherosclerotic cardiovascular disease (ASCVD), sodium-glucose cotransporter 2 inhibitor (SGLT-2I) or glucagon-like peptide-1 with proven cardiovascular benefit is recommended Receptor agonist (GLP-1RA), SGLT-2I is preferred in patients at high risk of heart failure
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For most patients with stronger glucose-lowering needs who require injectable medications, ADA guidelines favor initiation of GLP-1RA rather than insulin
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Controlling Blood Pressure Although the treatment process is similar, the 2017 ACC/AHA Guidelines for the Prevention, Evaluation, and Management of Hypertension in Adults and the 2017 ADA Diabetes and Hypertension Position Statement differ significantly in terms of hypertension definitions and goals
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The ADA does not advocate a uniform blood pressure target, but rather risk stratification to avoid overtreatment of frail patients with comorbidities and to reduce the likelihood of polypharmacy and adverse drug events
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Given the significant clinical heterogeneity of T2D patients, treatment strategies should be patient-centered and shared decision-making
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A multidisciplinary approach should be used to ensure that patients achieve blood pressure goals safely, as the rigorous protocols and intensive follow-up used in randomized controlled trials are difficult to reproduce in real-world clinical practice
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Lipid-lowering therapy is an integral part of reducing cardiovascular risk in an all-round way.
Both primary and secondary prevention of diabetes require timely and aggressive lipid-lowering therapy.

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A life>
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Given the consistent and compelling evidence that statins reduce cardiovascular risk, statins are the cornerstone of the treatment of dyslipidemia in patients with diabetes
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The 2018 cholesterol guidelines recommend statins as first-line treatment for the primary and secondary prevention of diabetes
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In patients with established ASCVD, the highest-intensity statin tolerable should be initiated or continued, with the goal of a more individualized approach to low-density lipoprotein-cholesterol (LDL-C) At least 50% lower
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For primary prevention of T2D, at least moderate-intensity statins should be considered based on age, absolute ASCVD risk, or the presence of risk-enhancing factors
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Consider non-statin therapy, including ezetimibe, PCSK9 inhibitors, eicosapentaenoic acid, after a comprehensive assessment of risk, LDL-C levels after optimal statin therapy, and presence of hypertriglyceridemia Ethyl esters, bile acid sequestrants, and fibrates
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In lipid-lowering therapy, an ongoing shared decision-making process that focuses on net clinical benefit, patient preference, potential cost issues, and medication adherence should be a consistent approach to treatment
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Antithrombotic therapy Antiplatelet therapy-based secondary prevention is well established in T2D patients
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For primary prevention of CVD in T2D patients, a patient-centred approach needs to be used to carefully weigh the relative benefits and risks of antithrombotic therapy
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CVD screening Many imaging tests can improve risk stratification in asymptomatic T2D patients, but data supporting routine screening are limited
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Coronary artery calcification (CAC) appears to be the most feasible indication for lipid-lowering and antiplatelet therapy
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The 2018 Cholesterol Guidelines and the 2019 ACC/AHA Guidelines for Primary Prevention of Cardiovascular Disease recommend moderate-intensity statin therapy for adults 40-75 years of age with diabetes without further risk stratification
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The National Lipid Association's scientific statement on CAC scores recommends escalation to high-intensity statins when the CAC score is >100
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If CAC scores are helpful in statin prescribing, it is also considered reasonable to use them in patients 30-39 years of age with chronic diabetes and >75 years of age
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The National Lipid Association and Cardiovascular Computed Tomography Association guidelines also consider aspirin use reasonable if the CAC score is >100
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Ischaemia testing is currently not recommended in asymptomatic diabetic patients
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Bibliography: Joshua J.
Joseph, Prakash Deedwania, Tushar Acharya, et al.
Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association.
Circulation.
2022 Jan 10; CIR0000000000001040.
doi: 10.
1161 /CIR.
0000000000001040.
Online ahead of print.