5.4.0.0 Lifestyle and Phar­ma­co­log­ic In­ter­ven­tions

In­ten­sive lifestyle in­ter­ven­tion fo­cus­ing on weight loss through de­creased caloric in­take and in­creased phys­i­cal ac­tiv­i­ty as per­formed in the Ac­tion for Health in Di­a­betes (Look AHEAD) trial may be con­sid­ered for im­prov­ing glu­cose con­trol, fitness, and some ASCVD risk fac­tors (153). Pa­tients at in­creased ASCVD risk should re­ceive as­pirin and a statin and ACE in­hibitor or ARB ther­a­py if the pa­tient has hy­per­ten­sion, un­less there are contrain­di­ca­tions to a par­tic­u­lar drug class. While clear benefit ex­ists for ACE in­hibitor or ARB ther­a­py in pa­tients with di­a­bet­ic kid­ney dis­ease or hy­per­ten­sion, the benefits in pa­tients with ASCVD in the ab­sence of these con­di­tions are less clear, especial­ly when LDL choles­terol is con­comi­tant­ly con­trolled (154,155). In pa­tients with prior MI, ac­tive angi­na, or HFrEF, β-‍block­ers should be used (156).