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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

Coronary heart disease risk clinical management plan (C1445948)
Concepts	Intellectual Product (T170)
English	Coronary heart disease risk clinical management plan
Spanish	plan de manejo clinico de riesgo de enfermedad coronaria
Parent Concepts	Clinical management plan (C1445941)
Sources	SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System)