Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Combination therapy (statin/niacin) hasn’t demonstrated additional CV benefit over statins alone, may raise risk of stroke & is not generally recommended. A

Statin therapy is contraindicated in pregnancy. B

Consider aspirin therapy (75–162 mg/day) C

• Consider aspirin therapy (75–162 mg/day) C

• As a primary prevention strategy in those with type 1 or type 2 diabetes at increased cardiovascular risk

• Includes most men or women with diabetes age ≥50 years who have at least one additional major risk factor, including:

• Family history of premature ASCVD
• Hypertension
• Smoking
• Dyslipidemia
• Albuminuria

Aspirin is not recommended for ASCVD prevention for adults with DM at low ASCVD risk, since potential adverse effects from bleeding likely offset potential benefits. C

• Aspirin is not recommended for ASCVD prevention for adults with DM at low ASCVD risk, since potential adverse effects from bleeding likely offset potential benefits. C

• Low risk: such as in men or women with diabetes aged <50 years with no major additional ASCVD risk factors)

• In patients with diabetes <50 years of age with multiple other risk factors (e.g., 10-year risk 5–10%), clinical judgment is required. E

Use aspirin therapy (75–162 mg/day) as secondary prevention in those with diabetes and history of ASCVD. A

• Use aspirin therapy (75–162 mg/day) as secondary prevention in those with diabetes and history of ASCVD. A

• For patients w/ ASCVD & aspirin allergy, clopidogrel (75 mg/day) should be used. B

• Dual antiplatelet therapy is reasonable for up to a year after an acute coronary syndrome. B

Screening

• Screening

• In asymptomatic patients, routine screening for CAD isn’t recommended & doesn’t improve outcomes provided ASCVD risk factors are treated. A

• Consider investigations for CAD with:

• Atypical cardiac symptoms (e.g. unexplained dyspnea, chest discomfort)
• Signs or symptoms of associated vascular disease incl. carotid bruits, transient ischemic attack, stroke, claudication or PAD
• EKG abnormalities (e.g. Q waves) E

Treatment

• Treatment

• In patients with known ASCVD, use aspirin and statin therapy (if not contraindicated) A and consider ACE inhibitor therapy C to reduce risk of cardiovascular events.

• In patients with a prior MI, β-blockers should be continued for at least 2 years after the event. B

Treatment

• Treatment

• In patients with symptomatic heart failure, TZDs should not be used. A

• In type 2 diabetes, patients with stable CHF, metformin may be used if renal function is normal but should be avoided in unstable or hospitalized patients with CHF. B

Screening

• Screening

• At least once a year, assess urinary albumin and estimated glomerular filtration rate (eGFR):

• In patients with type 1 diabetes duration of ≥5 years B
• In all patients with type 2 diabetes B
• In all patients with comorbid hypertension B

Treatment

• Treatment

• Optimize glucose control to reduce risk or slow progression of diabetic kidney disease. A

• Optimize blood pressure control to reduce risk or slow progression of diabetic kidney disease. A

Treatment (2)

• Treatment (2)

• For people with non-dialysis dependent diabetic kidney disease, dietary protein intake should be ~0.8 g/kg body weight per day. For patients on dialysis, higher levels of dietary protein intake should be considered. B

Treatment (3)

• Treatment (3)

• In nonpregnant patients with diabetes and hypertension, either an ACE inhibitor or ARB is recommended for those with modestly elevated urinary albumin excretion (30–299 mg/g creatinine) B and is strongly recommended for patients w/ urinary albumin excretion ≥300 mg/g creatinine and/or eGFR <60. A

Treatment (4)

• Treatment (4)

• When ACE inhibitors, ARBs, or diuretics are used, consider monitoring serum creatinine & potassium levels for increased creatinine or changes in potassium. E

• Continued monitoring of UACR in patients with albuminuria on an ACE inhibitor or ARB is reasonable to assess treatment response & progression of diabetic kidney disease. E

Treatment (5)

• Treatment (5)

• An ACE inhibitor or ARB isn’t recommended for primary prevention of diabetic kidney disease in patients with diabetes with normal BP, normal UACR (<30 mg/g creatinine) & normal eGFR. B

• When eGFR is <60, evaluate and manage potential complications of CKD. E