http://www.fpnotebook.com/

Coronary Artery Disease Prevention in Diabetes

See Also
1. Coronary Risk Management
2. Diabetes Mellitus
Epidemiology
1. Cardiovascular disease causes 65% of NIDDM deaths
Management: (ABC: A1C, Blood Pressure, Cholesterol)
1. Aggressively control hyperglycemia
  1. See Diabetes Mellitus Glucose Management
  2. Glycosylated Hemoglobin <7%
2. Aggressively control Hypertension
  1. See Hypertension in Diabetes Mellitus
  2. Goals parallel those for known cardiovascular disease
    1. Keep Blood Pressure below 130/80
3. Lipid disorders
  1. See Low Fat Diet
  2. See AntiHyperlipidemic
  3. Goals parallel those for known cardiovascular disease
    1. LDL Cholesterol <100 mg/dl
    2. HDL Cholesterol >40 mg/dl
    3. Triglycerides <150 mg/dl
  4. Increased LDL Cholesterol
    1. Start Statin
    2. Consider Colesevelam (Welchol) as may also lower A1C by 0.5%
      1. Do not use in Hypertriglyceridemia
      2. Zieve (2007) Clin Ther 29(1):74
    3. Consider Niacin as adjunctive therapy if needed
    4. Grundy (2002) Arch Intern Med 162:1568
  5. Increased Triglycerides and low LDL Cholesterol
    1. Elevations despite optimized glucose management
    2. Start Gemfibrozil
4. Other important preventive measures
  1. Aspirin in all diabetic patients
  2. Tobacco Cessation
  3. Control Obesity (reduce Body Mass Index)
    1. See Nutrition in Diabetes Mellitus
    2. See Exercise in Diabetes Mellitus
Resources
1. Diabetes-Related Cardiovascular Risk Calculator
  1. http://www.dtu.ox.ac.uk/index.php?maindoc=/ukpds/
References

Navigation Tree

Please see the Terms and Conditions. Please also see the privacy statement regarding advertising on this page. Although access to this page is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians.

This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.