Managing Diabetes to Prevent Cardiovascular Disease: A Guideline Quiz
Diabetes is a primary risk factor for atherosclerotic cardiovascular disease. Find out how well you know the guideline recommendations for reducing that risk with the first of 4 quizzes.
FOCUS ON: Preventive Cardiology
Interest is growing rapidly in preventive cardiology as a subspecialty of cardiovascular medicine.1,2 The field encompasses a number of medical conditions associated with cardiovascular risk, including diabetes, hyperlipidemia, hypertension, and obesity.
Components of preventive cardiology include risk assessment, lifestyle management, therapeutics, biomarkers and/or genetics.
Patient Care will focus in this series on managing the 4 primary risk factors for atherosclerotic cardiovascular disease noted above. Find out what you know about guideline-recommended approaches to diabetes management in primary and secondary CV prevention with quiz #1.
1. The ACC/AHA ASCVD 10-year ASCVD risk estimator accounts for all of the above with one excption -- which one?
Answer: B. Diabetes duration. The ADA recommends annual cardiovascular risk evaluation for all patients with diabetes,1 and states that the ACC/AHA 10-year ASCVD risk estimator2 is “generally” useful for doing so. However, the estimator does not account for duration of diabetes or diabetes complications like albuminuria. While the estimator does ask about sex and race, some research suggests variability in results based on these factors.3
2. According to ACC/AHA guidelines, how much moderate intensity exercise should adults with T2D perform per week to decrease their risk of ASCVD?
Answer: B. 150 minutes per week. According to ACC/AHA 2019 guidelines on the primary prevention of cardiovascular disease, individuals with T2D should engage in 150 minutes per week of moderate intensity exercise, or 75 minutes per week of vigorous intensity exercise, in order to improve glycemic control, lose weight, and decrease the risk of ASCVD.
3. Which of the agents above is FDA-approved for the reduction of CV risk among patients with T2D and established ASCVD?
Answer: D. All of the agents. The ADA recommends an SGLT2 inhibitor or GLP-1 receptor agonist in patients with T2D who have established ASCVD or are at high cardiovascular risk.1
Results from several large cardiovascular outcome trials have found that the SGLT2 inhibitors as a class are cardioprotective, leading to FDA approval for canagliflozin, empagliflozin, and dapagliflozin for reducing CV risk among patients with T2D and established ASCVD.
Key cardiovascular outcomes trials. The EMPA-REG2 and CANVAS3 trials found that empagliflozin and canagliflozin, respectively, were associated with significantly reduced major adverse cardiovasular events (MACE) and hospitalization for HF among patients with T2D and established ASCVD.
The DECLARE-TIMI4 trial found that dapagliflozin was associated with decreased risk for a composite of CV death and hospitalization for HF in high risk patients. Dapagliflozin recently received FDA approval for reducing CV risk in adults with heart failure and reduced ejection fraction, regardless of whether or not they have T2D.5
According to ACC/AHA guidelines, which of the agents above should be used as first-line therapy to help decrease ASCVD risk in adults with T2D?
Answer: C. Metformin. ACC/AHA guidelines recommend metformin as first-line therapy at diagnosis, along with lifestyle modification, in order to treat hyperglycemia and decrease ASCVD risk. Younger individuals and those with mildly elevated HbA1c at diagnosis may consider a trial of lifestyle modification for 3-6 months before starting metformin.
