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CDE Diabetes

Flashcards: Treatment of Hypertension (Chapter 26)

Hypertension affects the majority of people with diabetes and acts as a potent multiplier for cardiovascular and microvascular complications. These flashcards are designed to help pharmacists and healthcare professionals quickly recall the 2018 Clinical Practice Guidelines regarding blood pressure thresholds, lifestyle interventions, and the specific indications for renin-angiotensin-aldosterone system (RAAS) blockade.

Key Topics Covered:

  • Therapeutic Targets: Memorizing the recommended blood pressure target of <130/80 mmHg for optimal renal and cardiovascular protection.

  • Drug Selection: Identifying when to initiate therapy with an ACE inhibitor or ARB, specifically in patients with cardiovascular disease, chronic kidney disease, or albuminuria.

  • Lifestyle Interventions: Recalling specific targets for sodium restriction (<2000 mg/day), alcohol limits, and the DASH diet.

  • Combination Therapy: Understanding the need for combination therapy (often required for most patients) and the caution against combining ACE inhibitors with ARBs.

  • Renal Protection: Reviewing the role of antihypertensive agents in delaying the progression of diabetic nephropathy.

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CDE Diabetes

Practice Exam: Treatment of Hypertension (Chapter 26)

Hypertension affects the majority of people with diabetes and acts as a potent multiplier for cardiovascular and microvascular complications. The 2018 Clinical Practice Guidelines provide aggressive targets and specific pharmacotherapy algorithms to reduce the risk of stroke, myocardial infarction, and renal failure.

This practice exam tests your ability to apply the evidence-based recommendations for blood pressure thresholds, treatment initiation, and the selection of antihypertensive agents based on comorbidities.

Key Concepts Covered in This Exam:

  • Therapeutic Targets: Mastering the recommended target of <130/80 mmHg for people with diabetes to maximize renal and cardiovascular protection.

  • First-Line Therapy: Identifying the specific indications (e.g., cardiovascular disease, chronic kidney disease, albuminuria) for choosing an ACE inhibitor or Angiotensin Receptor Blocker (ARB) as initial therapy.

  • Lifestyle Interventions: Applying non-pharmacologic strategies, including sodium restriction (<2000 mg/day), the DASH diet (high fruit/vegetable/low-fat dairy intake), and alcohol moderation.

  • Treatment Algorithms: Understanding when to start with standard-dose monotherapy versus when combination therapy may be required.

  • Renal Protection: Recognizing the unique role of renin-angiotensin-aldosterone system (RAAS) blockade in delaying the progression of diabetic nephropathy.

1. According to the guidelines, what is the recommended daily sodium intake target for people with diabetes and hypertension?

2. Case: A patient with type 2 diabetes asks about the relationship between BP and cardiovascular risk. What should you explain?

3. Case: A clinician is considering whether to use early combination therapy. According to the guidelines, in what clinical context has early combination therapy historically been encouraged?

4. Case: A team is developing guidelines for elderly patients with diabetes and active CAD. What precaution does the chapter specifically mention for this population when initiating antihypertensive therapy?

5. Case: A 65-year-old man with type 2 diabetes has established coronary artery disease and a BP of 145/90 mmHg. What class of antihypertensive should be recommended as initial therapy?

6. How many servings of fruits and vegetables per day are recommended as part of healthy behaviour interventions for hypertension?

7. A patient asks about checking their blood pressure at home. According to the guidelines, what should you tell them?

8. Case: A patient with type 2 diabetes asks whether the benefits of BP lowering are greater in people with or without diabetes. Based on the evidence, what should you tell them?

9. What is the target diastolic blood pressure for people with diabetes according to Diabetes Canada?

10. Case: A patient with type 2 diabetes is found to have a BP of 156/96 mmHg. When counseling about lifestyle modifications, what should you emphasize about the role of healthy behaviour interventions?

11. Case: A clinician asks why intensive BP lowering might be particularly important in people with diabetes. According to the guidelines, what is the most evidence-based response?

12. Case: A patient with type 2 diabetes asks whether there is good evidence for the systolic BP target of <130 mmHg. What is the most accurate response based on the guideline evidence?

13. Case: A 62-year-old man with type 2 diabetes has additional CV risk factors including dyslipidemia and family history of premature CVD. His urinary albumin excretion is normal. What is the recommended first-line antihypertensive?

14. According to Diabetes Canada, what is the target systolic blood pressure for people with diabetes?

15. Case: A 60-year-old woman with type 2 diabetes and CKD stage 3 has a BP of 150/94 mmHg. What is the recommended first-line antihypertensive therapy?

16. Case: A healthcare team is debating whether to change their BP target from <130/80 mmHg to <140/90 mmHg based on ACCORD BP findings. What is the most accurate interpretation of the current evidence?

17. Case: A 70-year-old woman with type 2 diabetes and autonomic neuropathy is being started on antihypertensive therapy. What precaution should be considered?

18. How many servings of low-fat dairy products per day are recommended as part of healthy behaviour interventions?

19. Case: A 58-year-old man with type 2 diabetes has a BP of 148/92 mmHg. He has no known CVD but has microalbuminuria. What is the most appropriate first-line antihypertensive agent?

20. What is the maximum recommended alcohol consumption for men with diabetes and hypertension?

21. A diabetes educator is reviewing the evidence about stroke prevention with BP lowering. According to multiple meta-analyses cited in the guidelines, what additional protection does lowering BP <130 mmHg confer?

22. Case: A 52-year-old woman with type 2 diabetes and hypertension has normal urinary albumin excretion and no CVD. Her BP is 142/88 mmHg. Which of the following would be an appropriate first-line agent?

23. According to the guidelines, how often should people with diabetes have their blood pressure checked at minimum?

24. Case: A 55-year-old man with type 2 diabetes, hypertension, and dyslipidemia (no CVD or albuminuria) asks which antihypertensive class has additional renal benefits beyond BP lowering. What should you tell him?


 

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CDE Diabetes

Study Guide: Treatment of Hypertension (Chapter 26)

1. Overview & Targets

Hypertension affects fewer than 50% of people with diabetes, yet it is a major driver of cardiovascular disease (CVD), stroke, and nephropathy. Aggressive blood pressure (BP) control is often more effective at reducing CVD events than aggressive glycemic control.

  • Diagnostic Threshold: Hypertension in diabetes is defined as 130/80 mmHg.

  • Treatment Target: The goal for essentially all adults with diabetes is < 130/80 mmHg.

    • Note: This is lower than the general population target (often <140/90).

2. Diagnosis and Measurement

  • Method: Diagnosis should be based on proper in-office measurements (averaged) or, preferably, out-of-office measurements like Ambulatory Blood Pressure Monitoring (ABPM) or home monitoring to rule out “White Coat” hypertension.

  • Assessment: At diagnosis, assess for end-organ damage (retinopathy, nephropathy) and cardiovascular risk factors.

3. Management Strategy (The Algorithm)

The choice of initial medication depends heavily on the presence of existing complications or risk factors.

A. Lifestyle Intervention (First Line for All)

  • Weight: Achieve and maintain a healthy body weight.

  • Diet:

    • Sodium: Reduce intake to < 2,000 mg/day.

    • Pattern: DASH diet (high fruits/vegetables, low-fat dairy).

    • Potassium: Dietary potassium intake should be increased (unless renal insufficiency exists).

  • Alcohol: Limit to 2 drinks/day (men) and 1 drink/day (women).

  • Activity: Accumulate 150 mins/week of moderate-to-vigorous aerobic exercise.

B. Pharmacotherapy: Initial Choice

Scenario 1: With Cardiovascular or Kidney Disease

  • Indication: If the patient has known CVD, Chronic Kidney Disease (CKD), Albuminuria, or additional CV risk factors.

  • First Line: ACE Inhibitor (ACEi) or Angiotensin Receptor Blocker (ARB).

    • Rationale: These agents provide specific renoprotection and CV risk reduction beyond just lowering BP.

Scenario 2: No Complications/Risk Factors

  • Indication: Patient has diabetes and hypertension but no albuminuria, CVD, or other major risk factors.

  • First Line Options:

    • ACE Inhibitor

    • ARB

    • Dihydropyridine CCB (e.g., Amlodipine)

    • Thiazide-like diuretic (e.g., Indapamide, Chlorthalidone).

C. Combination Therapy

Most people with diabetes will require 2 or more agents to reach the target of <130/80 mmHg.

  • If not at target: Add a second agent from a different class.

  • Preferred Combinations:

    • ACEi/ARB + DHP-CCB (Dihydropyridine Calcium Channel Blocker).

    • ACEi/ARB + Thiazide-like diuretic.

  • Caution: Do not combine an ACEi with an ARB (risk of hyperkalemia/renal failure without added benefit).

D. Beta-Blockers?

  • Beta-blockers are NOT indicated as first-line therapy for uncomplicated hypertension in diabetes.

  • Exceptions: Use them if there is a specific cardiac indication (e.g., recent Myocardial Infarction, Heart Failure).

4. Special Considerations

  • Pregnancy:

    • Contraindicated: ACE inhibitors, ARBs, and Statins must be stopped prior to conception (teratogenic).

    • Safe Agents: Methyldopa, Labetalol, Nifedipine XL.

  • Renal Monitoring: When starting ACEi/ARB, monitor serum creatinine and potassium (expect a small, acceptable rise in creatinine; watch for hyperkalemia).

  • Orthostatic Hypotension: Monitor for drops in BP upon standing, especially in the elderly or those with autonomic neuropathy.

5. 2018 Diabetes Canada Clinical Practice Guidelines Recommendations

Key takeaways from the “Recommendations” section (Page S189).

  1. Threshold & Target: People with diabetes should be treated to achieve a systolic BP < 130 mmHg [Grade C] and diastolic BP < 80 mmHg [Grade B].

  2. Initial Therapy (with complications): For persons with CVD, CKD (including albuminuria), or additional CV risk factors, an ACEi or ARB is recommended as initial therapy [Grade A, Level 1A].

  3. Initial Therapy (without complications): For others, acceptable initial choices include ACEi, ARB, DHP-CCB, or thiazide-like diuretic [Grade A to B depending on drug].

  4. Add-on Therapy: If targets are not achieved, add a second agent. If initial therapy was an ACEi/ARB, a DHP-CCB is preferred over a diuretic [Grade A, Level 1A].

  5. Pregnancy: Women trying to conceive should discontinue ACEi/ARBs [Grade D, Consensus].

Reference:

Tobe SW, Gilbert RE, Jones C, Leiter LA, Prebtani APH, Woo V. Treatment of Hypertension. Canadian Journal of Diabetes. 2018;42:S186-S189. doi:10.1016/j.jcjd.2017.10.011
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CDE Diabetes

Flashcards: Dyslipidemia (Chapter 25)

Dyslipidemia is a pervasive risk factor in diabetes, requiring aggressive intervention to mitigate cardiovascular risk. These flashcards are designed to help pharmacists and healthcare professionals memorize the 2018 Clinical Practice Guidelines regarding statin initiation, specific cholesterol targets, and the management of refractory cases or severe hypertriglyceridemia.

Key Topics Covered:

  • Therapeutic Targets: Memorizing the primary goal of LDL-C consistently <2.0 mmol/L (or >50% reduction) and alternative targets like Non-HDL-C <2.6 mmol/L.

  • Statin Indications: Identifying the criteria for initiating statin therapy, such as age 40, diabetes duration >15 years, or the presence of microvascular complications.

  • Intensification: Reviewing the steps for intensifying therapy with ezetimibe or PCSK9 inhibitors when statin monotherapy fails to reach targets.

  • Hypertriglyceridemia: Understanding the specific indication for fibrates—primarily to prevent pancreatitis in patients with triglycerides >10.0 mmol/L—rather than for routine cardiovascular prevention.

  • Screening Protocols: Recalling the recommended frequency for lipid profile screening at diagnosis and during treatment follow-up.

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CDE Diabetes

Practice Exam: Dyslipidemia (Chapter 25)

Dyslipidemia is one of the most significant modifiable risk factors for cardiovascular disease in people with diabetes. The 2018 Clinical Practice Guidelines simplify the management approach by focusing on statin therapy for high-risk individuals and establishing clear, aggressive targets for Low-Density Lipoprotein Cholesterol (LDL-C).

This practice exam tests your ability to identify who requires statin therapy, when to intensify treatment with second-line agents, and how to manage hypertriglyceridemia safely.

Key Concepts Covered in This Exam:

  • Indications for Statin Therapy: Identifying the broad criteria for treatment initiation, including age 40, duration of diabetes >15 years, or the presence of microvascular complications.

  • Therapeutic Targets: Mastering the primary goal of therapy: achieving an LDL-C consistently <2.0 mmol/L or a >50% reduction from baseline.

  • Intensification: Knowing when to add ezetimibe or PCSK9 inhibitors for patients who do not reach targets despite maximally tolerated statin therapy.

  • Hypertriglyceridemia: Understanding that fibrates are generally used to prevent pancreatitis when triglycerides are >10.0 mmol/L, rather than for primary CVD prevention.

  • Screening Intervals: Recalling the recommendation to screen lipid profiles at diagnosis and annually (or every 3 to 6 months after starting treatment).

Please go to Practice Exam: Dyslipidemia (Chapter 25) to view this quiz
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CDE Diabetes

Study Guide: Dyslipidemia (Chapter 25)

1. Overview & Pathophysiology

Dyslipidemia is a major risk factor for cardiovascular disease (CVD) in diabetes. The lipid profile in diabetes (especially Type 2) often presents a specific “atherogenic” pattern:

  • Typical Pattern:

    • High Triglycerides (TG).

    • Low HDL-Cholesterol.

    • Normal or slightly elevated LDL-Cholesterol (but the particles are typically small, dense, and highly atherogenic).

  • Primary Goal: Lowering LDL-C is the primary target because it has the strongest evidence for CVD risk reduction.

2. Screening

  • Who: All adults with diabetes.

  • When: At diagnosis and then every 1–3 years as clinically indicated.

  • Components: Lipid profile (TC, HDL-C, TG, LDL-C, Non-HDL-C).

3. Treatment Indications (Who Needs a Statin?)

This is one of the most high-yield areas for the CDE exam. Statin therapy is recommended based on risk category, not just baseline LDL levels.

A. Secondary Prevention (High Risk)

  • Indication: Any person with diabetes and Clinical Cardiovascular Disease (CVD).

  • Action: Start Statin.

B. Primary Prevention (Type 2 Diabetes)

  • Age 40 years: Start Statin (regardless of baseline LDL).

  • Age < 40 years: Start Statin IF one of the following is present:

    • Microvascular complications (retinopathy, kidney disease, neuropathy).

    • Assessment warrants therapy based on other guidelines (e.g., Familial Hypercholesterolemia).

C. Primary Prevention (Type 1 Diabetes)

  • Age 40 years: Start Statin.

  • Age < 40 years: Start Statin IF:

    • Duration of diabetes years AND age years.

    • Microvascular complications are present.

4. Treatment Targets

Once a patient is on a statin, you treat to a specific target.

  • Primary Target:

    • LDL-C 2.0 mmol/L

    • OR 50% reduction from baseline LDL-C.

  • Alternate Targets (if LDL is accurate):

    • Non-HDL-C mmol/L.

    • Apolipoprotein B (ApoB) g/L.

5. Pharmacotherapy Management

A. Statins (HMG-CoA Reductase Inhibitors)

  • First-line therapy.

  • Pregnancy: Contraindicated. Women of childbearing potential must use reliable contraception or stop statins before conception.

B. Second-Line Agents If targets are not met with maximally tolerated statin doses:

  • Ezetimibe: Can be added to statins.

  • PCSK-9 Inhibitors (e.g., Evolocumab, Alirocumab): Injectable agents that dramatically lower LDL; indicated if targets are missed despite statin + ezetimibe, or for Familial Hypercholesterolemia.

C. Hypertriglyceridemia

  • Lifestyle: Weight loss, optimal glycemic control, and restricting alcohol/refined sugars are key.

  • Fibrates:

    • Generally NOT recommended for reducing CVD risk (evidence from FIELD and ACCORD-Lipid trials was weak).

    • Exception: Use fibrates to prevent pancreatitis if Triglycerides are severe ( mmol/L).

6. 2018 Diabetes Canada Clinical Practice Guidelines Recommendations

Key takeaways from the “Recommendations” section.

  1. Statin Initiation: Recommended for:

    • Adults with clinical CVD [Grade A, Level 1].

    • Adults age 40 years [Grade A, Level 1 for T2D; Grade D for T1D].

    • Adults age < 40 years with microvascular complications or long duration (>15 yrs duration and age >30) [Grade D, Consensus].

  2. Targets: The primary goal is LDL-C consistently mmol/L or a reduction from baseline [Grade D, Consensus].

  3. Fibrates: Fibrate therapy should not be used routinely for the purpose of reducing CVD risk [Grade A, Level 1A].

  4. Severe Hypertriglyceridemia: In individuals with TG mmol/L, a fibrate may be used to reduce the risk of pancreatitis [Grade D, Consensus].

  5. Combination Therapy: For those not at LDL target, ezetimibe or PCSK9 inhibitors may be used [Grade A/D depending on drug].

Reference:

Mancini GBJ, Hegele RA, Leiter LA. Dyslipidemia. Canadian Journal of Diabetes. 2018;42:S178-S185. doi:10.1016/j.jcjd.2017.10.019
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CDE Diabetes

Flashcards: Screening for the Presence of Cardiovascular Disease (Chapter 24)

Cardiovascular disease is the leading cause of death in diabetes, yet a significant proportion of patients present with “silent” ischemia—suffering a myocardial infarction without prior warning symptoms. These flashcards are designed to help pharmacists and healthcare professionals quickly recall the 2018 Clinical Practice Guidelines regarding risk stratification, the specific indications for resting ECGs versus stress testing, and the criteria for specialist referral.

Key Topics Covered:

  • The “Silent” Threat: Understanding why traditional symptom-based assessment may fail in diabetes, as many individuals do not experience chest pain before a cardiac event.

  • Screening Protocols: Memorizing the recommendations for baseline resting ECGs (e.g., age >40, duration of diabetes >15 years) and the frequency of repeat testing.

  • Stress Testing Indications: Distinguishing between patients who require exercise stress testing (e.g., those with typical/atypical symptoms or PAD) and the recommendation against routine screening in asymptomatic individuals.

  • Prognostic Assessment: Identifying when exercise stress testing is most useful for assessing long-term prognosis in high-risk groups.

  • Referral Criteria: Recognizing the clinical signs—such as unexplained dyspnea or carotid bruits—that warrant immediate referral to a cardiac specialist.

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CDE Diabetes

Practice Exam: Screening for the Presence of Cardiovascular Disease (Chapter 24)

Individuals with diabetes are at a significantly higher risk of developing cardiovascular disease (CVD) and often present with “silent” ischemia, meaning they may suffer a myocardial infarction without experiencing typical chest pain. The 2018 Clinical Practice Guidelines provide specific criteria for when—and how—to screen for coronary artery disease (CAD) to ensure resources are used effectively.

This practice exam tests your ability to identify which patients require routine screening (e.g., resting ECG) versus those who require further investigation (e.g., stress testing) based on their symptom profile and risk factors.

Key Concepts Covered in This Exam:

  • The “Silent” Threat: Understanding that a large proportion of people with diabetes will have no symptoms prior to a fatal or nonfatal myocardial infarction.

  • Resting ECG Guidelines: Identifying who should receive a baseline resting ECG and how often it should be repeated (e.g., every 3 to 5 years) for patients with specific risk factors.

  • Indications for Stress Testing: Recognizing that routine stress testing is not recommended for asymptomatic individuals, but is indicated for those with typical or atypical cardiac symptoms, or associated diseases like peripheral artery disease (PAD).

  • Assessment of Prognosis: Knowing when exercise stress testing is useful for assessing prognosis in high-risk individuals versus when functional imaging might be preferred.

  • Referral Criteria: Determining when a patient should be referred to a cardiac specialist for further evaluation.

Please go to Practice Exam: Screening for the Presence of Cardiovascular Disease (Chapter 24) to view this quiz

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CDE Diabetes

Study Guide: Screening for the Presence of Cardiovascular Disease (Chapter 24)

1. Overview & Rationale

Cardiovascular disease (CVD) is the leading cause of death in diabetes. The presentation of CVD in this population is often atypical.

  • The “Silent” Threat: A large proportion of people with diabetes may have no symptoms (silent ischemia) before a fatal or non-fatal myocardial infarction (MI).

  • Risk Status: People with diabetes are at higher risk of developing heart disease at an earlier age compared to those without diabetes.

  • The Goal: To identify individuals with established severe coronary artery disease (CAD) who might benefit from revascularization or intensive medical therapy.

2. Screening Modalities

Different tests are used based on the patient’s symptoms and ability to exercise.

A. Resting Electrocardiogram (ECG)

  • Utility: Can detect previous silent MI, Left Ventricular Hypertrophy (LVH), or rhythm abnormalities.

  • Limitation: A normal resting ECG does not rule out CAD (it can be normal in >50% of patients with confirmed CAD).

B. Exercise Stress Testing (EST)

  • Indication: Useful for assessing prognosis in high-risk individuals.

  • Challenges: Exercise capacity is frequently impaired in people with diabetes due to obesity, neuropathy, or deconditioning, which can limit the test’s accuracy.

C. Stress Imaging (MPI or Echocardiography)

  • Indication: Used when the patient cannot exercise adequately or has a baseline ECG that is uninterpretable (e.g., Left Bundle Branch Block, LVH, paced rhythm).

  • Types:

    • Myocardial Perfusion Imaging (MPI): Uses a vasodilator (e.g., dipyridamole/adenosine) to mimic exercise stress.

    • Stress Echocardiography: Uses dobutamine to increase heart rate.

D. Coronary Artery Calcium (CAC) Scoring

  • Utility: Excellent for risk stratification (determining if a patient is low vs. high risk).

  • Limitation: While it predicts risk, studies have not consistently shown that screening with CAC improves clinical outcomes compared to standard intensive risk factor management.

3. The "Asymptomatic" Controversy (High Yield)

One of the most critical concepts for the CDE exam is whether to screen patients who feel fine.

  • Routine Screening: Routine screening for CAD in asymptomatic people with diabetes is NOT recommended.

  • The Evidence: The DIAD Study (Detection of Ischemia in Asymptomatic Diabetics) showed that screening asymptomatic patients with stress imaging did not reduce cardiac events (MI or death) compared to standard care.

    • Why? Medical management (statins, BP control, A1C control) is now so effective that identifying mild/moderate ischemia early doesn’t necessarily change the treatment plan or outcome.

4. Who Should Be Tested? (The Indications)

While routine screening is out, targeted testing is in.

1. Resting ECG (Baseline & Repeat): Consider for:

  • Age years.

  • Duration of diabetes years (Type 1).

  • Presence of microvascular complications (retinopathy, nephropathy, neuropathy).

  • Frequency: Repeat every 2 years in these groups.

2. Stress Testing (ECG or Imaging): Mandatory for:

  • Typical or Atypical cardiac symptoms (e.g., unexplained shortness of breath).

  • Associated diseases: Peripheral Artery Disease (PAD) or Carotid Artery Disease.

  • Sedentary individuals planning to begin vigorous or intense exercise.

  • High-risk occupations (e.g., airline pilots).

5. Diabetes Canada Clinical Practice Guidelines Recommendations

ey takeaways from the “Recommendations” section (Page S175).

  1. Baseline ECG: A resting ECG should be performed in individuals with:

    • Age years [Grade D, Consensus].

    • Duration of diabetes years (Type 1) [Grade D, Consensus].

    • Microvascular complications [Grade D, Consensus].

    • (Repeat every 2 years).

  2. No Routine Screening: Routine cardiac screening (stress test/imaging) is not recommended for asymptomatic adults with diabetes [Grade A, Level 1A].

  3. Indications for Stress Testing: Stress testing should be performed for:

    • Typical or atypical cardiac symptoms (e.g., unexplained dyspnea) [Grade C, Level 3].

    • Signs of associated PAD or Carotid disease [Grade D, Consensus].

    • Sedentary individuals planning vigorous exercise [Grade D, Consensus].

  4. Choice of Test:

    • Exercise ECG is the initial test if the patient can exercise and has a normal resting ECG [Grade D, Consensus].

    • Pharmacologic stress echo or nuclear imaging should be used if the patient cannot exercise or has resting ECG abnormalities [Grade D, Consensus].

Reference:

Poirier P, Bertrand OF, Leipsic J, Mancini GBJ, Raggi P, Roussin A. Screening for the Presence of Cardiovascular Disease. Canadian Journal of Diabetes. 2018;42:S170-S177. doi:10.1016/j.jcjd.2017.10.025
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CDE Diabetes

Flashcards: Cardiovascular Protection in People with Diabetes (Chapter 23)

Cardiovascular disease is the leading cause of death for people with diabetes. These flashcards are designed to help pharmacists and healthcare professionals quickly recall the comprehensive strategies outlined in the 2018 Clinical Practice Guidelines—from vascular protection medications to lifestyle interventions—to aggressively lower morbidity and mortality.

Key Topics Covered:

  • Risk Assessment: Differentiating between proximate (<10 years) and lifetime risk, particularly for younger patients who may have a high relative risk despite low short-term absolute risk.

  • The “ABCDEs” Strategy: Memorizing the components of comprehensive vascular protection: A1C, Blood pressure, Cholesterol, Drugs, Exercise/Healthy Eating, Screening for complications, and Smoking cessation.

  • Lipid Management: Recalling the specific indications for statin therapy and the primary target of LDL-C 2.0 mmol/L (or >50% reduction).

  • Cardioprotective Agents: Identifying the specific roles of SGLT2 inhibitors and GLP-1 receptor agonists in reducing major cardiovascular events (MACE) and heart failure hospitalization.

  • Antiplatelet Therapy: Understanding the nuances of aspirin use for secondary prevention versus the limited indications for primary prevention.