The American Diabetes Association (ADA) Standards of Medical Care in Diabetes 2018 includes guidance relating to cardiovascular disease (CVD) and risk management in nonpregnant adults with diabetes. Recommendations address diagnosis and treatment of CV risk factors (hypertension and dyslipidemia), aspirin use, screening for and treatment of coronary heart disease (CHD), and lifestyle interventions. Among the guidance and recommendations:
- Blood pressure should be measured at every routine clinical visit. Patients with elevated blood pressure (≥140/90) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension. (Grade B recommendation)
- Lifestyle modification focusing on weight loss (if indicated); the reduction of saturated fat, trans fat, and cholesterol intake; increase of dietary n-3 fatty acids, viscous fiber, and plant stanols/sterols intake; and increased physical activity should be recommended to improve the lipid profile in patients with diabetes. (Grade A recommendation)
- Use aspirin therapy (75-162 mg/day) as secondary prevention in those with diabetes and a history of ASCVD. (Grade A recommendation)
- In asymptomatic patients, routine screening for coronary artery disease is not recommended as it does not improve outcomes as long as ASCVD risk factors are treated. (Grade A recommendation)
Chamberlain JJ, Johnson EL, Leal S, Rhinehart AS, Shubrook JH, Peterson L. Cardiovascular disease and risk management: Review of the American Diabetes Association Standards of Medical Care in Diabetes 2018. [Published online ahead of print April 3, 2018]. Ann Intern Med. doi:10.7326/M18-0222.