Atherosclerotic cardiovascular disease (ASCVD)ddeﬁned as acute coronary syndromes (ACSs), a history of myocardial infarction (MI), stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origindis the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes.
The common conditions coexisting with type 2 diabetes (e.g., hypertension and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Numerous studies have shown the efﬁcacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with diabetes. Large beneﬁts are seen when multiple risk factors are addressed simultaneously. There is evidence that measures of 10-year coronary heart disease (CHD) risk among U.S. adults with diabetes have improved signiﬁcantly over the past decade (1) and that ASCVD morbidity and mortality have decreased (2–4).
In all patients with diabetes, cardiovascular risk factors should be systematically assessed at least annually. These risk factors include hypertension, dyslipidemia, smoking, a family history of premature coronary disease, and the presence of albuminuria. Abnormal risk factors should be treated as described in these guidelines.
HYPERTENSION/BLOOD PRESSURE CONTROL
Hypertension, deﬁned as a sustained blood pressure $140/90 mmHg, is a common comorbidity of type 1 and type 2 diabetes. The prevalence of hypertension depends on type of diabetes, age, sex, BMI, and race/ethnicity. Hypertension is a major risk factor for both ASCVD and microvascular complications. In type 1 diabetes, hypertension is often the result of underlying diabetic kidney disease, while in type 2 diabetes, it usually coexists with other cardiometabolic risk factors. Please refer to the American Diabetes Association (ADA) position statement “Diabetes and Hypertension” for a detailed review (5).
Source ADA 2017
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