Cardiovascular Disease Prevention and Management Clinical Practice Guidelines (2018)

Risk Factor Screening

Every 3 years, screen all individuals aged 40 years and older, or those at high risk, for diabetes using fasting plasma glucose (FPG) and/or glycosylated hemoglobin (A1C) levels, and a risk calculator. Test earlier and/or follow up more often (every 6-12 months) with either FPG and/or A1C, or consider a postload glucose (2hPG) in a 75 g oral glucose tolerance test (OGTT) in very high-risk persons, using a risk calculator, or in those with additional type 2 diabetes risk factors, including, but not limited to, the following:

Age 40 years and older
First-degree relative with type 2 diabetes
Member of a high-risk population (African, Arab, Asian, Hispanic, Indigenous/South Asian descent; low socioeconomic status)
History of prediabetes, gestational diabetes (GDM), or delivery of a macrosomic infant
Presence of microvascular or cardiovascular (CV) end-organ damage associated with diabetes
Presence of vascular risk factors (HDL-C <1.0 mmol/L in males, <1.3 mmol/L in females; triglycerides ≥1.7 mmol/L; hypertension; overweight; abdominal obesity; smoking) or associated diseases (history of pancreatitis, polycystic ovarian syndrome, acanthosis nigricans, hyperuricemia/gout, nonalcoholic steatohepatitis, psychiatric disorders [bipolar disorder, depression, schizophrenia], human immunodeficiency virus [HIV] infection, obstructive sleep apnea, cystic fibrosis)
Use of medications associated with diabetes (glucocorticoids, atypical antipsychotics, statins, highly active antiretroviral therapy, antirejection drugs)

To identify individuals with impaired glucose tolerance (IGT) or diabetes, consider testing with 2hPG in a 75 g OGTT in those with an FPG of 6.1-6.9 mmol/L and/or an AIC of 6.0%-6.4%.

Use standardized BP measurement techniques and validated equipment for all methods (automated office BP [AOBP], non-AOBP, ambulatory BP monitoring, and home BP monitoring). Upper arm electronic (oscillometric) measurement devices are preferred over auscultation. Note the following:

AOBP (preferred): The displayed mean BP is high when systolic BP (SBP) is ≥135 mmHg or diastolic BP (DBP) is ≥85 mmHg.
Non-AOBP: The mean BP is high when the SBP is ≥140 mmHg or the DBP is ≥90 mmHg; it is high-normal when the SBP is 130-139 mmHg and/or the DBP is 85-89 mmHg.
Ambulatory BP monitoring: Hypertension is diagnosed with a mean awake SBP of ≥135 mmHg or DBP of 85 mmHg, or with a mean 24-hour SBP of ≥130 mmHg or DBP of ≥80 mmHg.
Home BP monitoring: Hypertension is diagnosed with a mean SBP of ≥135 mmHg or DBP of ≥85 mmHg.

Screen plasma lipids in men and women aged 40 years and older (or postmenopausal women). Screen earlier for those in ethnic groups at increased risk (eg, South Asian or First Nations individuals). Inform patients of their global risk to improve efficacy of risk factor modification.

Screen lipids at any age in patients with the following features:

Clinical evidence of atherosclerosis
Abdominal aortic aneurysm, diabetes mellitus, arterial hypertension, stigmata of dyslipidemia, chronic kidney disease, obesity, inflammatory disease, HIV infection, erectile dysfunction, chronic obstructive pulmonary disease, hypertensive disease of pregnancy
Current tobacco use (regularly update patients' tobacco use; advise smoking cessation)
Family history of CVD

Heart failure

Assess patients with known/suspected heart failure for multimorbidity, frailty, cognitive impairment, dementia, and depression; all of these may affect treatment, therapeutic adherence, follow-up, or prognosis.

Hypertension

Assess patients' global CV risk.

Overweight/obesity

Screen patients for eating disorders, depression, and psychiatric disorders, as appropriate.

Stroke

For those at risk of, or who have had, a stroke, evaluate for vascular disease risk factors, lifestyle management issues, and use of oral contraceptives or hormone replacement therapy.

Provide information and counseling to individuals at risk of stroke about possible strategies for lifestyle and risk factor modifications, and refer to appropriate specialists as needed.

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