What are the ESC guidelines on cardiovascular disease (CVD) management and prevention in patients with diabetes or prediabetes?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

In September 2019, the European Society of Cardiology (ESC), in collaboration with the European Association for the Study of Diabetes (EASD), released updated guidelines aimed at managing and preventing cardiovascular disease (CVD) in patients with diabetes or prediabetes. Patient CV risk is classified in the guidelines as follows [406] :

  • Medium CV risk - Young patients without other CV risk factors who have had diabetes for less than 10 years
  • High CV risk - Patients who lack target-organ damage but have had diabetes for over 10 years and in whom at least one other risk factor exists
  • Very high CV risk - Patients with CVD or target-organ damage or in whom type 1 diabetes has been present for more than 20 years

The recommendations include the following [406] :

  • In drug-naïve patients with type 2 diabetes and established CVD, administration of a sodium-glucose cotransporter–2 (SGLT-2) inhibitor or glucagonlike peptide-1 (GLP-1) receptor agonist should be immediately initiated or added to existing metformin treatment
  • Based on a cardiovascular outcome trial (CVOT), it is recommended that aspirin be used in high- and very high–risk patients (on an individual basis) but not in moderate-risk patients
  • Very high–risk patients in whom low-density lipoprotein (LDL) cholesterol levels are persistently high even with maximal statin and ezetimibe therapy or who have statin intolerance should undergo proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitor treatment
  • An HbA1c level of under 7% is advised, particularly in young adults who have had diabetes for only a short time
  • In patients with medium, high, and very high CV risk, lipid targets of 2.5 mmol/L, 1.8 mmol/L, and below 1.4 mmol/L, respectively, are recommended

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