Sec­tion 10. Car­dio­vas­cu­lar Dis­ease and Risk Man­age­ment

(https:/​/​doi.org/​10.2337/​dc23-​S010)

Rec­om­men­da­tion 10.1 was re­vised with up­dat­ed defini­tions of hy­per­ten­sion. These rec­om­men­da­tions align with the cur­rent defini­tion of hy­per­ten­sion ac­cord­ing to the Amer­i­can Col­lege of Car­di­ol­o­gy and Amer­i­can Heart As­so­ci­a­tion.

Rec­om­men­da­tion 10.4 on blood pres­sure treat­ment goals in in­di­vid­u­als with di­a­betes was re­vised to tar­get a blood pres­sure of <130/​80 mmHg. The dis­cus­sion of the ev­i­dence to sup­port this rec­om­men­da­tion was ex­ten­sive­ly re­vised. In ad­di­tion, the re­cent­ly re­port­ed re­sults of the STEP (Strat­e­gy of Blood Pres­sure In­ter­ven­tion in the El­der­ly Hy­per­ten­sive Pa­tients) tri­al were added. Rec­om­men­da­tion 10.7 was up­dat­ed to con­sid­er phar­ma­co­log­i­cal treat­ment in peo­ple with di­a­betes and a confirmed blood pres­sure ≥130/​80. Table 10.1 and Fig. 10.2 were up­dat­ed ac­cord­ing­ly.

In the sub­sec­tion “Preg­nan­cy and Anti­hy­per­ten­sive Med­i­ca­tions,” the re­sults of the CHAP (Chron­ic Hy­per­ten­sion and Preg­nan­cy) tri­al were in­clud­ed to fur­ther sup­port the cur­rent treat­ment goal rec­om­men­da­tions in preg­nant in­di­vid­u­als with di­a­betes.

Rec­om­men­da­tion 10.20 was re­vised to rec­om­mend the use of high-​in­ten­si­ty statin ther­a­py in in­di­vid­u­als with di­a­betes aged 40–75 years at high­er risk, in­clud­ing those with one or more atheroscle­rot­ic car­dio­vas­cu­lar dis­ease risk fac­tors, to re­duce the LDL choles­terol by ≥50% of base­line and to tar­get an LDL choles­terol goal of <70 mg/​dL.

Rec­om­men­da­tion 10.21 was added to con­sid­er adding treat­ment with eze­tim­ibe or a PCSK9 in­hibitor to max­i­mum tol­er­at­ed statin ther­a­py in these in­di­vid­u­als.

Rec­om­men­da­tions 10.22 and 10.23 were added to rec­om­mend con­tin­u­ing statin ther­a­py in adults with di­a­betes aged >75 years cur­rent­ly re­ceiv­ing statin ther­a­py and to rec­om­mend that it may be rea­son­able to ini­ti­ate mod­er­atein­ten­si­ty statin ther­a­py in adults with di­a­betes aged >75 years, re­spec­tive­ly.

Rec­om­men­da­tion 10.26 was up­dat­ed to rec­om­mend treat­ment with high­in­ten­si­ty statin ther­a­py in in­di­vid­u­als with di­a­betes and es­tab­lished atheroscle­rot­ic car­dio­vas­cu­lar dis­ease to tar­get an LDL choles­terol re­duc­tion of ≥​50% from base­line and an LDL choles­terol goal of <55 mg/​dL. If this goal is not achieved on max­i­mum tol­er­at­ed statin ther­a­py, the ad­di­tion of eze­tim­ibe or a PCSK9 in­hibitor is now rec­om­mend­ed.

Lan­guage re­gard­ing ev­i­dence in the sec­tion “S­tatin Treat­men­t” was re­vised to con­sid­er the ev­i­dence sup­port­ing low­er LDL choles­terol goals in peo­ple with di­a­betes with and with­out es­tab­lished car­dio­vas­cu­lar dis­ease.

In the sub­sec­tion “Com­bi­na­tion Ther­a­py for LDL Choles­terol Low­er­ing” a para­graph was added to in­clude in­clisir­an, an siR­NA di­rect­ed against PCSK9, as a new FDAap­proved choles­terol-​low­er­ing ther­a­py.

Rec­om­men­da­tion 10.42b was added to rec­om­mend treat­ment with a sodi­um–glu­cose co­trans­porter 2 in­hibitor in in­di­vid­u­als with type 2 di­a­betes and estab­lished heart fail­ure with ei­ther pre­served or re­duced ejec­tion frac­tion to im­prove symp­toms, phys­i­cal lim­i­ta­tions, and qual­i­ty of life. The dis­cus­sion of ev­i­dence to sup­port this new rec­om­men­da­tion was in­clud­ed in the last para­graph of the sec­tion “Glu­cose-​Low­er­ing Ther­a­pies and Heart Fail­ure.”

Rec­om­men­da­tion 10.43 was added to rec­om­mend the ad­di­tion of finerenone in the treat­ment of in­di­vid­u­als with type 2 di­a­betes and chron­ic kid­ney dis­ease with al­bu­min­uria treat­ed with max­i­mum tol­er­at­ed dos­es of ACE in­hibitor or an­giotensin re­cep­tor block­er.

This sec­tion is en­dorsed for the fifth con­sec­u­tive year by the Amer­i­can Col­lege of Car­di­ol­o­gy.