Scope of the Problem.
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among patients with diabetes. Therefore, managing ASCVD risk is crucial in preventing the progression of atherosclerosis and reducing serious events like heart attacks and strokes in individuals with diabetes.
2023 ADA Guidelines.
In 2023, the American Diabetes Association recommends the following 3-step guidance to patients with diabetes and established heart disease:
- First, patients should modify their lifestyle to adopt healthy habits, which are the key to preventing ASCVD.
- This involves making necessary weight loss adjustments, choosing a Mediterranean or DASH diet, reducing the intake of saturated and trans fats, increasing the intake of omega-3 fatty acids, viscous fiber, and plant stanols/sterols, as well as improving physical activity levels.
- Next, patients should add high-intensity statin therapy as part of their healthy routines. They should take high-intensity statins, like rosuvastatin (≥20 mg) or atorvastatin (≥40 mg) per day.
- The purpose of using a high-intensity statin is to decrease LDL cholesterol levels by more than 50% from the baseline and bring it below 55 mg/dL. If the aforementioned goals cannot be achieved with lifestyle adjustments or statins alone, it is appropriate to supplement the patient’s medical regimen with ezetimibe or PCSK9 inhibitors, such as Repatha or Praluent.
Summary of Recommendations.
To manage patients with diabetes who already have cardiovascular disease, a practical and simplified approach involves establishing healthy lifestyle routines and lowering LDL cholesterol levels below 55 mg/dL. This can be achieved by combining dietary changes, physical activity, weight loss, supplements, statins, ezetimibe, and PCSK9 inhibitors.
Dr. Tashko
