According to current guidelines, CVD risk ≥ 20% in patients with diabetes is considered a CVD risk equivalent. For these patients, the same high-intensity statin therapy is recommended as for those with existing CVD. On the basis of clinical trials that have evaluated the efficacy of combining of statin and nonstatin therapy, ADA guidelines recommend considering adding additional cholesterol-lowering therapy to maximally tolerated statin therapy for patients at very high CVD risk.
High-intensity statins are recommended for all patients with T2D and atherosclerotic CVD.
Control of hypertension is an important strategy for CVD risk reduction among individuals with T2D. Randomized clinical trials have clearly shown that treatment of hypertension to blood pressure < 140/90 mm Hg reduces both cardiovascular events and microvascular complications. Lower blood pressure targets may be appropriate for certain patients if they can be safety attained.
Although patients with T2D commonly have elevated triglycerides, whether or not therapy to reduce triglycerides lowers risk of CHD events warrants further research. Currently, ADA guidelines recommend addressing hypertriglyceridemia with dietary and lifestyle changes, including weight loss and abstinence from alcohol. Severe hypertriglyceridemia (fasting triglycerides ≥ 500 mg/dL and especially > 1000 mg/dL) may necessitate pharmacologic therapy (fibric acid derivatives and/or fish oil) and reduction in dietary fat to decrease the risk for acute pancreatitis.
Learn more about cardiovascular risk reduction in individuals with T2D.
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Cite this: Romesh Khardori. Fast Five Quiz: Type 2 Diabetes and Cardiovascular Disease Risk - Medscape - Feb 15, 2022.