Cardiovascular Disease And Risk Management

Question 1

In patients with diabetes, how often should cardiovascular risk factors be assessed?

Answer 1

Annually

Question 2

Should DM patients be screened for asymptomatic CAD with stress tests,angiography, etc?

Answer 2

No, as it has not been shown to improve cardiac outcomes

Question 3

Which DM patients should receive aspirin (75 -162 mg) therapy for primary prevention?

Answer 3

T1DM and T2DM patients with greater than 10-year risk of >10% which includes:

• Men > 50 years and Women > 60 years with at least one of the following risk factors
  1. Family history of CVD
  2. HTN
  3. Smoking
  4. Dyslipidemia
  5. Albuminuria

ASA not recommended in patients with less than 5% 10-year CVD risk since adverse effects from bleeding likely offset potential benefits.
Clinical judgement required for patients with 5-10% risk

Question 4

ADA BP goals

Answer 4

• less than 140/90
• may consider 130/80 if able to achieve without undue burden

*The 2015 guidelines changed the diastolic BP goal from 80 to 90

Question 5

AACE/ACE BP goal

Answer 5

• About 130/80
• Consider less than 120/80 if able to achieve safely
• Use higher goals for elderly, frail, or comorbid conditions

Question 6

What are the nonpharmacologic recommendations for HTN management?

Answer 6

• Weight loss
• DASH diet
• Moderate ETOH
• Decreased salt
• Increased potassium
• Increased activity

Question 7

ADA Recommendations for BP in pregnant patients with diabetes and HTN

Answer 7

BP targets of 110-129/65-79