CV Risk Assessment in DM PDF

CV Risk Assessment in DM Elham Omran Elgdhafi Consultant Cardiologist , Tripoli University Hospital Associated Professor, College Of Medicine, University Of Tripoli 2023 ESC Guidelines for the management of CVD in patients with diabetes  Individuals with T2DM are at a two- to four-fold higher ri...

CV Risk Assessment in DM Elham Omran Elgdhafi Consultant Cardiologist , Tripoli University Hospital Associated Professor, College Of Medicine, University Of Tripoli 2023 ESC Guidelines for the management of CVD in patients with diabetes  Individuals with T2DM are at a two- to four-fold higher risk of developing CVD during their lifetime alongside its manifestations CAD, stroke, HF, and AF, as well as peripheral artery diseases (PAD).  Many patients with CVD have undiagnosed T2DM.  Given that having diabetes and CVD, especially at a younger age, has a major impact on prognosis, it is important to screen patients with CVD for diabetes and to assess CV risk in individuals with diabetes, and evaluate them for CV and kidney disease Chan JC, Lim L-L, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2020; For the prevention and management of both ASCVD and heart failure, cardiovascular risk factors should be systematically assessed at least annually in all people with diabetes. These risk factors include duration of diabetes, obesity/overweight, hypertension, dyslipidemia, smoking, a family history of premature coronary disease, chronic kidney disease (CKD), and the presence of albuminuria. When assessing CV risk in individuals with T2DM, it is important to consider medical and family history, symptoms, findings from examination, laboratory and other diagnostic test results, and the presence of ASCVD ( atherosclerotic CVD ) , or severe TOD ( target-organ damage ) Essential to inform clinical decision‐making  Severe TOD (i) Estimated glomerular filtration rate (eGFR) 300 mg/g; stage A3). (iv) Presence of microvascular disease in at least three different sites (e.g. microalbuminuria (stage A2) plus retinopathy plus neuropathy.  A diagnosis of T2D has implications for recommendations for several ASCVD risk-mitigating therapies, including:  high-intensity statin therapy and non-statin LDL cholesterol-lowering therapy with more aggressive LDL cholesterol targets  the use of ACE inhibitors / ARBS independent of B/P consideration; and consideration for a more aggressive systolic B/P  Aside from counseling on healthy lifestyle, including recommendations for systematic engagement of physical activity for health, focus on a healthy diet, weight management, and smoking abstinence, the ESC guidelines recommend the prescription of both an SGTL2i and a GLP-1 RA to achieve CVD reduction in people with T2D with or at high risk for ASCVD based on an abundance of data from randomized controlled trials.  SCORE2-Diabetes: estimating 10-year cardiovascular disease risk:  In patients aged ≥40 years with T2DM without ASCVD or severe TOD, it recommended to estimate 10-year CVD risk using the SCORE2-Diabetes algorithm SCORE2-Diabetes integrates information on conventional CVD risk factors (i.e. age, smoking status, systolic blood pressure [SBP], and total and high-density lipoprotein [HDL]-cholesterol) with diabetes-specific information (e.g. age at diabetes diagnosis, HbA1c, and eGFR).This model is calibrated to four clusters of countries (low, moderate, high, and very high CVD risk) using the similar methodology of the SCORE2 and SCORE2-Older Persons (SCORE2-OP) Cardiovascular risk categories in type 2 diabetes 2023 ESC Guidelines for the management of CVD in patients with diabetes The American College of Cardiology ASCVD risk calculator (Risk Estimator Plus) is generally a useful tool to estimate 10-year risk of a first ASCVD event  Coronary artery calcium (CAC) scoring improves CVD risk prediction and reclassifies risk when added to conventional CVD risk factor-based estimation models. A CAC score of >100 Agatston units or ≥75th percentile for age, sex, and ethnicity favors up-classification of CVD risk.  Internal or external carotid plaque may also improve CVD risk prediction.  femoral artery plaque detection may improve CVD risk prediction.  Arterial stiffness, as assessed by pulse wave velocity (PWV), is associated with increased risk of CVD events and improves CVD risk stratification. Updates in the management of CVD and DM Cardiovascular risk reduction in patients with diabetes: targets and treatments weight reduction Physical Diet & activity Nutrient Glycaemic Smoking targets cessation Recommendation for reducing wt in patients with DM ± CVD Recommendation for Nutrition in patients with DM ± CVD Recommendation for Physical activity / Exercise in patients with DM ± CVD Recommendation for Physical activity / Exercise in patients with DM ± CVD Recommendation for Smoking cessation in patients with DM ± CVD Recommendation for Glycemic targets in patients with DM ± CVD Recommendations for glucose-lowering treatment for patients with type 2 DM & ASCVD to reduce CV risk  Diabetes and Chronic Kidney Disease  Approximately 30% to 40% of individuals with T2D will develop CKD.  Screening for CKD in individuals with T2D has a class I indication in the 2023 ESC guidelines  the 2022 Kidney Disease Improving Global Outcomes guidelines: routine screening using eGFR as calculated by the CKD‐Epidemiology Collaboration formula as well as urine albumin to creatinine ratio testing is recommended Morales J, Handelsman Y. Cardiovascular outcomes in patients with diabetes and kidney disease. J Am Coll Cardiol. 2023 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Diabetes management in chronic kidney disease: synopsis of the KDIGO 2022 clinical practice guideline update. Ann Intern Med. 2023  kidney‐protective effects of SGTL2is indicated for those with CKD (eGFR 30 mg/g) and eGFR >20 mL/min per 1.73 m ( Class I A ESC guidelines for the management of DM 2023 )  SGTL2is should be used in combination with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and finerenone as the contemporary 3 pillars of evidence‐based kidney‐protective therapies in individuals with T2D and CKD (Diabetes management in chronic kidney disease: synopsis of the KDIGO 2022 clinical practice guideline update. Ann Intern Med. 2023 )  GLP‐1 Ras is recommended to achieve adequate glycemic control in individuals with eGFR >15 mL/min per 1.73 m2. ( Class I A ESC guidelines for the management of DM 2023 )