It is estimated that by 2050, 1 in 3 U.S. individuals will have type 2 diabetes (T2D) and cardiovascular disease (CVD) is the most common cause of death for in these patients. Prevention of CVD among individuals with T2D is therefore of great public health importance.
The scientific statements from the American Diabetes Association (ADA), American Heart Association (AHA) and American College of Cardiology (ACC) regarding CVD prevention for patients with T2D, and risk factors for CVD, were recently synthesized and published in the Journal of American College of Cardiology . The review article focused on 2 major domains: (1) lifestyle management and (2) CVD risk factor management, and the key messages are provided below.
- Exercise: ≥150 minutes/week moderate intensity over ≥3 days/week with ≤2 consecutive days without exercise
- Nutrition: Mediterranean style diet may improve glycemic control and CVD risk factors; consumption of fruits, vegetables, legumes, whole grains, and dairy in place of other carbohydrate sources; carbohydrate monitoring as an important strategy for glycemic control
- Weight management: 3%-5% rate of weight loss for clinically meaningful health benefits
- Smoking cessation: Quit cigarettes, other tobacco products, or e-cigarettes
CVD Risk Factor Management:
- Glycemic control: Achieve HbA1c ≤7% in most patients; more or less may be appropriate depending on patient characteristics and medical history
- Blood pressure: Achieve <140/90 m Hg for most patients
- Cholesterol: Individuals 40-75 years of age with LDL 70-189 mg/dL should receive at least moderate-intensity statin (30-50% reduction); high-intensity statin (>50% reduction) should be given if age 40-75 years of age with CVD risk factors
- Aspirin: 75-162 mg is reasonable for patients ≥50 years of age with at least 1 CVD risk factor without increased gastrointestinal bleeding risk
The authors encourage implementation of appropriate lifestyle and CVD risk factor management to alleviate the burden of CVD among patients with T2D. This information may be broadly useful for clinicians, cardiologists, and other physician specialties caring for patients with T2D.
 Newman, J.D., et al., Primary Prevention of Cardiovascular Disease in Diabetes Mellitus. J Am Coll Cardiol, 2017. 70(7): p. 883-893.