LDL-C < 1.4 mmol/L in ultra-high-risk patients! Industry standards for the diagnosis and treatment of type 2 diabetes mellitus combined with cardiovascular disease released

Recently, the China Internal Specialist Alliance of Crine and Metabolic Diseases released the industry standard
for the diagnosis and treatment of type 2 diabetes combined with cardiovascular disease.
This criterion is largely similar
to the corresponding recommendations of cardiology.

The main recommendations of the standard are as follows:

LDL-C target value: <1.
4 mmol/L in patients with diabetes mellitus and ultra-high-risk patients, <1.
8 mmol/L in very high-risk patients, and <2.
6 mmol/L
in high-risk patients.

Lipid-lowering therapy should be initiated with medium-strength statins
.
If the LDL-C level cannot reach the standard, it can be used in combination with other lipid-modifying drugs (such as ezetimibe), and PCSK9 inhibitors
can be added to very high-risk patients if statins combined with ezetimibe still do not meet the standard after 4~6 weeks.

After statin therapy, if the target value is still not achieved without HDL-C, fibrate and high-purity fish oil preparations can be added to statins, and for patients with severe hypertriglyceridemia (≥ 5.
7 mmol/L), drugs that mainly lower triglycerides and very low-density lipoprotein cholesterol (VLDL-C) (such as fibrates and high-purity fish oil preparations)
should be considered first.

For chronic heart failure, drugs such as diuretics, renin-angiotensin system inhibitors, β blockers, aldosterone receptor antagonists, ivabradine, and digitalis may be used
.

Patients at high risk of ASCVD or ASCVD and heart failure are recommended in addition to standard therapies such as metformin with glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium-glucose co-transporter 2 inhibitors (SGLT2i)
with evidence of cardiovascular and chronic kidney disease benefit.

If blood pressure levels exceed 120/80 mmHg, lifestyle interventions should be initiated to prevent hypertension
.

Hypertension is established, home blood pressure measurement and, if necessary, 24-hour ambulatory blood pressure testing are recommended, with a blood pressure target of 130/80 mmHg
<.

Monostatic combinations (ARB/calcium antagonists, ARBs, or ACEs/diuretics)
are more recommended for combination regimens.

In patients with evidence of end-organ damage such as proteinuria and left ventricular hypertrophy, renin-angiotensin-aldosterone system blockers (including ACEI, ARB, ARNI) are supported, and ACE inhibitors and ARB are not recommended
.

Patients with diabetes mellitus and ASCVD at high risk, or patients with ASCVD, need aspirin (75~150 mg/d) as primary and secondary prevention, and the risk of
bleeding should be fully assessed.
For allergy or intolerance, clopidogrel (75 mg/day)
can be used.

Source:

[1] China Endocrine Metabolic Disease Specialist Alliance.
Industry standard for the diagnosis and treatment of type 2 diabetes mellitus combined with cardiovascular disease.
Chinese Journal of Endocrinology and Metabolism, 2022, 38(10): 839-842.

Gao Xiufang, Li Yong, Ge Junbo, et al.
Clinical application of new antihyperglycemic drugs to improve cardiovascular and renal outcomes: Chinese experts recommend.
Chinese Journal of Circulation, 2020, 35: 231-238.
DOI: 10.
3969/j.
issn.
1000-3614.
2020.
03.
002.