Atherosclerotic cardiovascular disease (ASCVD), defined as a history of acute coronary syndrome, myocardial infarction, stable or unstable angina or coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral artery disease (PAD) including aortic aneurysm and is the primary cause of morbidity and mortality in individuals with diabetes. Managing multiple risk factors simultaneously can prevent or slow the progression of ASCVD. Heart failure (HF) is another major cause of morbidity and mortality from cardiovascular disease. (CVD). Hypertension is a major risk factor for ASCVD, heart failure, and microvascular complications.
*An ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) is suggested for treatment of hypertension in people with coronary artery disease (CAD) or urine albumin-to-creatinine ratio 30–299 mg/g creatinine and is strongly recommended for individuals with urine albumin-to-creatinine ratio ≥300 mg/g creatinine. †Dihydropyridine calcium channel blocker (CCB). ‡Thiazide-like diuretic; long-acting agents shown to reduce cardiovascular events, such as chlorthalidone and indapamide, are preferred. BP, blood pressure. Adapted from de Boer IH, Bangalore S, Benetos A, et al. Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes Care 2017;40:1273–1284.
*An ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) is suggested for treatment of hypertension in people with coronary artery disease (CAD) or urine albumin-to-creatinine ratio 30–299 mg/g creatinine and is strongly recommended for individuals with urine albumin-to-creatinine ratio ≥300 mg/g creatinine. †Dihydropyridine calcium channel blocker (CCB). ‡Thiazide-like diuretic; long-acting agents shown to reduce cardiovascular events, such as chlorthalidone and indapamide, are preferred. BP, blood pressure. Adapted from de Boer IH, Bangalore S, Benetos A, et al. Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes Care 2017;40:1273–1284.
Screening for Asymptomatic and Undiagnosed CVD
Preventing the Development of Symptomatic HF in People With Diabetes
ACEi, ACE inhibitor; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; LVEF, left ventricle ejection fraction; SGLT2, sodium–glucose cotransporter 2.
How often should you check lipids?
For people with prediabetes or diabetes not on lipid-lowering therapy, check at diagnosis and at least annually thereafter.
Check lipids at initiation of lipid-lowering therapy, 4–12 weeks after initiation or dose changes, and annually thereafter.
Statin Therapy Potency Chart
| High-intensity statin therapy (lowers LDL cholesterol by ≥50%) | Moderate-intensity statin therapy (lowers LDL cholesterol by 30–49%) |
|---|---|
| Atorvastatin (40–80 mg) Rosuvastatin (20–40 mg) | Atorvastatin (10–20 mg) Rosuvastatin (5–10 mg) Simvastatin (20–40 mg) Pravastatin (40–80 mg) Lovastatin (40 mg) Fluvastatin XL (80 mg) Pitavastatin (1–4 mg) |
| High-intensity statin therapy (lowers LDL cholesterol by ≥50%) | Moderate-intensity statin therapy (lowers LDL cholesterol by 30–49%) |
|---|---|
| Atorvastatin (40–80 mg) Rosuvastatin (20–40 mg) | Atorvastatin (10–20 mg) Rosuvastatin (5–10 mg) Simvastatin (20–40 mg) Pravastatin (40–80 mg) Lovastatin (40 mg) Fluvastatin XL (80 mg) Pitavastatin (1–4 mg) |
Once-daily dosing. XL, extended release.
