By James F. McDonald Jr., DO, Temple Cardiologist
Everyone should be following a healthy lifestyle to prevent atherosclerotic cardiovascular disease (ASCVD). If your patient has diabetes, this is even more important. Diabetes is a major risk factor for ASCVD, a leading cause of morbidity and mortality. Moreover, patients with diabetes often have other risk factors, such as hypertension or elevated LDL levels. Implementing best practices to control risk factors can lead to significant decreases in ASCVD.
Assessing a patient’s risk using an approved risk calculator is a first step in prevention. It forms the basis for patient discussion and shared decision-making about therapy.
Lifestyle Changes
Current guidelines stress lifestyle interventions as key for patients with diabetes. They urge an individualized eating plan with different types of nutrient-dense foods in suitable portion sizes. Recommend the following:
- Eating fruits, vegetables, nuts, whole grains, lean protein sources, fish, and healthy fats
- Avoiding refined grains, sugar-sweetened beverages, red and processed meats, and foods containing trans fats
This type of diet can aid in glucose control and overall risk reduction. Weight loss, if needed, is another benefit. Patients with diabetes also need to monitor their carbohydrate intake.
At least 150 minutes per week of aerobic activity promotes glucose control and addresses other risk factors. This activity should be moderately to vigorously intense and spaced over at least three days during the week. In addition, the patient should do resistance training two or three times per week.
For the older patient with diabetes, flexibility and balance exercises are particularly important.
Drug Therapy
Current guidelines recommend metformin as a first-line agent for treating type 2 diabetes. Metformin lowers Hb A1c levels and weight. It has also been shown to improve cardiac outcomes. Other agents can be added for patients with additional ASCVD risk factors who have not achieved their target glucose range. These include SGLT-2 inhibitors and GLP-1 receptor agonists.
Hypertension Control
Control of high blood pressure focuses on lifestyle changes. Drug therapy is advised for patients when their blood pressure is 130/80 mm Hg or higher. These include:
- ACE inhibitors
- ARBs
- Beta-blockers
- Thiazide-like diuretics
- Calcium channel blockers
More than one drug may be needed to reach the target blood pressure goal. According to the American Diabetes Association, this target goal is individualized and based on a discussion with the patient.
Cholesterol Control
Statin therapy may be needed when LDL levels are high. Guidelines advise the following:
- Moderate-intensity statin therapy with atorvastatin, rosuvastatin, or simvastatin for patients between the ages of 40 to 75 years, regardless of their risk
- Moderate-intensity statin therapy (as above) for patients younger than age 40 with ASCVD risk factors
- Higher-dose therapy with atorvastatin or rosuvastatin for patients of any age with more than one risk factor for ASCVD
Your Role
As a primary care provider, you play a major role in helping patients achieve the best outcome possible. Implementing these best practices can help your patients reach this goal.
Referring Patients for Cardiology Care
You may refer patients to a preventive cardiologist at TUH-Northeastern or Temple Physicians at Palmer Park campuses. In addition, cardiovascular testing is available with immediate appointments at TUH-Episcopal and TUH-Northeastern campuses. To refer, call 800-TEMPLE-MED.