Top Things to Know: Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes
Published: January 10, 2022
Prepared by Sally S. Wong, PhD, RD, CDN, FAHA – Senior Science and Medicine Advisor
- Cardiovascular disease remains the leading cause of death and disability in patients with T2D.
- This AHA Scientific Statement focuses on 1) the evidence supporting and clinical utility of newer antihyperglycemic agents in improving glycemic control and reducing cardiovascular events in T2D; 2) the impact of blood pressure control on cardiovascular events in T2D; and 3) the role of newer lipid-lowering therapies in comprehensive cardiovascular risk management in adults with T2D.
- While efficacious therapies are available to improve cardiovascular risk factors, comprehensive management of various cardiovascular risk factors in T2D remains poor in the U.S. and around the world.
- A large number of randomized controlled trials have demonstrated that the risk of cardiovascular events can be significantly reduced by incorporating evidence-based therapies for control/modification of multiple cardiometabolic abnormalities in patients with T2D.
- Explanations for the discordance between the availability of effective therapies and poor glycemic control include medical factors (i.e., clinical inertia, monotherapy, patient adherence, cost, lack of guideline-based treatment); however, these all occur in the environmental context of a patient.
- Beneficial impacts in primary prevention of atherosclerotic cardiovascular disease (ASCVD) among those with T2D, though desired, remain to be established. For example, differences in therapy response across racial and ethnic groups deserve further evaluation.
- Many imaging tests can facilitate risk stratification in asymptomatic patients with T2D, but there is limited data to support routine screening.
- To advance management of cardiovascular risk factors, health care professionals must also address the social determinants of health in the delivery of health care.
- Lifestyle management of T2D includes diabetes self-management education and support, medical nutrition therapy, physical activity, smoking cessation, and psychosocial care.
- A patient-centered approach reframing clinical encounters to think about patients as people who live in families, communities and societies should be considered as part of the patient’s cardiovascular risk management.
Citation
Joseph JJ, Deedwania P, Acharya T, Aguilar D, Bhatt DL, Chyun DA, Di Palo KE, Golden SH, Sperling LS; on behalf of the American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; and Council on Hypertension. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association [published online ahead of print January 10, 2022. Circulation. doi: 10.1161/CIR.0000000000001040