Cardiovascular Disease Prevention and Management Clinical Practice Guidelines (2018)

Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE)

Reviewed and summarized by Medscape editors

November 01, 2018

Diagnostic Strategies


The diagnosis of diabetes is made with any of the following criteria:

  • FPG ≥7.0 mmol/L

  • A1C ≥6.5% (in adults, in the absence of factors affecting A1C accuracy; not for those with suspected type 1 diabetes)

  • 2hPG in a 75 g OGTT ≥11.1 mmol/L

  • Random plasma glucose (PG) ≥11.1 mmol/L

Heart failure

Measure levels of B-type natriuretic peptide (BNP)/N-terminal pro BNP (NT-proBNP) to help confirm/exclude a diagnosis of heart failure in an acute/ambulatory care setting when the cause of dyspnea is in doubt.

Before initiating cancer therapy known to impair left ventricular (LV) function in patients receiving potentially cardiotoxic cancer treatment, evaluate their LV ejection fraction (LVEF).


Laboratory workup includes the following tests:

  • Urinalysis

  • Blood chemisty (potassium, sodium, creatinine)

  • FBG and/or A1C

  • Serum total cholesterol, LDL, HDL, non-HDL-C, TGs; lipids may be drawn fasting/nonfasting

  • Standard 12-lead electrocardiography

Obtain echocardiography or nuclear imaging to assess LVEF in hypertensive patients with heart failure.

Consider regular home BP monitoring for hypertensive patients, particularly those with diabetes mellitus, chronic kidney disease, suspected nonadherence, demonstrated white coat effect, or masked hypertension (BP controlled in the office but not at home).

In patients whose large arm circumferences preclude use of standard upper arm measurement methods, use validated wrist devices for assessing BP.


When appropriate, obtain additional investigations (eg, liver enzyme tests, sleep studies) to screen for and exclude other common overweight/obesity-related health issues.


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