Skill Checkup: A 71-Year-Old Man With History of Type 2 Diabetes and Related Hypertension Experiences Retrosternal Pressure

Carolyn Newberry, MD, PNS


December 21, 2022

T2D is a prothrombotic state caused by altered platelet and function and coagulation parameters. It also is associated with higher rates of hypertension and dyslipidemia, which further exacerbate the risk for ischemic events. Management of stable CAD in patients with T2D should focus on aggressive CV risk reduction owing to the well-recognized association between T2D and CVD and outcomes. Goals of treatment should be to improve event-free survival and provide symptom relief that will improve the patient's quality of life and physical functioning.

Having experienced one stable ischemic event, this patient should be started on a dual antiplatelet regimen of low-dose aspirin and antiplatelet P2Y12 inhibitor (clopidogrel or ticagrelor), recommended by both the American Heart Association (AHA) and the American Diabetes Association (ADA) to reduce clotting and ischemic risk. An alternative is clopidogrel without aspirin, which decreases CV risk without increasing bleeding risk. Therapy should be continued for at least a year and possibly long term as long as this patient has low bleeding risk. Patients also benefit from CV risk factor management to achieve goals for blood pressure and lipids, as well as exercise and nutrition strategies. Patients who smoke should be encouraged to quit and offered support with smoking cessation tools.


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