Еврогайд ИБС+СД2

[Dr.Vad]

Новый Еврогайд по ИБС+СД2:

The European Society of Cardiology and the European Association for the Study of Diabetes (EASD) have together issued new guidelines on the management of diabetes, prediabetes, and cardiovascular disease, published in the February 6 issue of the European Heart Journal (Eur Heart J. 2007;28:88-136.)

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Study Highlights

Diabetes may be defined by a fasting glucose level of 126 mg/dL or greater or a 2-hour postload plasma glucose level of 200 mg/dL or greater. Most patients with incipient diabetes do not have both of these abnormalities present simultaneously.

While 50% of patients with diabetes have yet to be diagnosed with this disorder, mass screening for diabetes has not been recommended. However, targeted screening for patients at high risk of developing diabetes or with a history of cardiovascular disease should be considered.
Postprandial glucose levels are particularly related to the risk for future cardiovascular disease compared with fasting glucose levels. However, few studies have addressed the issue of whether reducing postprandial glucose reduces the risk for cardiovascular disease. The research that has been performed has yielded moderately positive results in reducing cardiovascular events.

Diabetes also increases the risk for cerebrovascular disease by 3- to 5-fold. Treatment of hypertension with a renin-angiotensin-system inhibitor may afford an augmented reduction in the risk for stroke among diabetic patients.

Physical exercise, diet control, weight loss, metformin, and rosiglitazone have been demonstrated to reduce the progression of impaired glucose tolerance to overt diabetes.

The goal for glycated hemoglobin levels among patients with diabetes is 6.5% or less. Metformin is a first-line medication for overweight patients with type 2 diabetes, and clinicians should augment therapy rapidly to reduce glucose values to target levels.

Statin therapy should be initiated for all patients without contraindications to medications who have diabetes and cardiovascular disease, with a low-density lipoprotein cholesterol goal level of 70 to 77 mg/dL. Patients with diabetes but no history of cardiovascular disease should receive statins if the total cholesterol level exceeds 135 mg/dL, and these patients should be treated to reduce low-density lipoprotein cholesterol levels by 30% to 40%. All patients with type 1 diabetes who are older than 40 years should be considered for statin therapy regardless of baseline cholesterol levels, and patients with type 1 diabetes between the ages of 18 and 39 years should be considered for statin therapy if they have additional cardiovascular risk factors.

Blood pressure should be lowered to less than 130/80 mm Hg among patients with diabetes. Treatment should include a renin-angiotensin-system inhibitor.
Treatment of coronary heart disease among patients with diabetes should not differ significantly from treatment of patient without diabetes. Both groups should receive similar doses of aspirin and beta-blocker medications, and clopidogrel may be considered as an additional treatment.

Angiotensin-converting enzyme inhibitors can reduce the risk for further cardiovascular events among patients with diabetes and established cardiovascular disease.

Generally, coronary artery bypass grafting is associated with reduced rates of revascularization compared with percutaneous coronary intervention among patients with diabetes. Elective percutaneous coronary intervention should include treatment with glycoprotein IIb/IIIa inhibitors among patients with diabetes.

Treatment with warfarin with a target international normalized ratio of 2 to 3 should be considered for all patients with diabetes and atrial fibrillation.

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[Dr.Vad]

AHA Guidelines for CVD Prevention in Women Focus on Lifetime Risk Factors

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[Dr.Vad]

Highlights

Initial treatment of musculoskeletal pain should include nonpharmacologic therapy, including physical therapy, heat/cold, and orthotics.

For patients who fail conservative therapy for musculoskeletal pain, NSAIDs may be chosen as a next step. Naproxen is probably the NSAID associated with the lowest risk for thrombosis.

Patients with a history of gastrointestinal tract bleeding or who are at high risk for bleeding who require analgesia should be prescribed acetaminophen first. For these patients who require NSAID therapy, proton-pump inhibitors have been demonstrated to reduce the risk for recurrent gastrointestinal tract bleeding among patients receiving low-dose aspirin.

Ibuprofen, but not rofecoxib, acetaminophen, or diclofenac, appears to reduce the physiologic efficacy of aspirin in preventing thrombosis. Current recommendations call for delaying ibuprofen dosing until at least 30 minutes after taking aspirin or at least 8 hours prior to aspirin dosing.

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