Coronary heart disease in Diabetics

2016 ADA Guideline Recommendations
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

Screening

"1.In asymptomatic patients, routine screening for coronary artery disease is not recommended as it does not improve outcomes as long as atherosclerotic cardiovascular disease risk factors are treated (Level of Evidence: A)"

"2. Consider investigations for coronary artery disease in the presence of any of the following: atypical cardiac symptoms (e.g., unexplained dyspnea, chest discomfort); signs or symptoms of associated vascular disease including carotid bruits, transient ischemic attack, stroke, claudication, or peripheral arterial disease; or electrocardiogram abnormalities (e.g., Q waves) (Level of Evidence: E)"

Treatment

"1.In patients with known atherosclerotic cardiovascular disease, use aspirin and statin therapy (if not contraindicated) "(Level of Evidence: A)" and consider ACE inhibitor therapy. (Level of Evidence: C) to reduce the risk of cardiovascular events."

"2.In patients with prior myocardial infarction, b-blockers should be continued for at least 2 years after the event (Level of Evidence: B)"

"3.In patients with symptomatic heart failure, thiazolidinedione treatment should not be used (Level of Evidence: A)"

"4.In patients with type 2 diabetes with stable congestive heart failure, metformin may be used if renal function is normal but should be avoided in unstable or hospitalized patients with congestive heart failure (Level of Evidence: B)"