The Latest in Cardiometabolic-Related Guidelines and Clinical Pearls

CMHC brings you a comprehensive list of the latest guidelines related to cardiometabolic health.

Diabetes Management

Hypertensionand Heart

Failure

Obesity andLifestyle

Managementin CVD

Dyslipidemia, Atherosclerosis, and CVD Risk

Reduction

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The Latest in Cardiometabolic-Related Guidelines and Clinical Pearls

Diabetes Management

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• Manage any cardiovascular risk factors (obesity, dyslipidemia and hypertension) when treating hyperglycemia in type 2 diabetic patients

• Individualize treatment targets in glycemic management by considering:

- Patient comorbidities

- Life expectancy

- Ability to follow treatment regimen

- Need for hypoglycemia avoidance

- Cardiovascular risk

• Blood pressure (BP) reminders:

- Measure during EVERY routine clinical care visit

- Urge diabetic patients to go 130/80 mm Hg

[or below] if these targets can be achieved without undue treatment burden

- Encourage at-home BP monitoring for diabetic patients (measure BP 2 or 3 times a week until BP is stabilized, then weekly thereafter)

CLINICAL PEARLS

2018 ADA Standards of Medical Care in Diabetes

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2018 AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

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Executive Summary - PDF Link

Diabetes and Hypertension: A Position Statement by the American Diabetes Association

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The Latest in Cardiometabolic-Related Guidelines and Clinical Pearls

Hypertensionand Heart

Failure

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2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

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2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Manage-ment of Heart Failure

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2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

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• Treatment of patients with HF according to evidence-based and guideline-directed medical and device therapy is crucial to improving patient outcomes

• Sacubitril/valsartan

- Should not give sacubitril/valsartan for at least 36 hours after last angiotensin converting enzyme (ACE) inhibitor

- Do not combine ACE inhibitors with sacubitril/valsartan (risk of angioedema)

- Lower doses appear to be effective; start

at lowest dose if mild to moderate renal insufficiency (GFR < 60 mL/min) or moderate hepatic disease

• Ivabradine

- The higher the heart rate (HR) the more ivabradine lowers the HR

- It is recommended to up titrate beta blockers to maximally tolerated doses first before adding ivabradine

- May not be as much benefit below a HR of approximately 77 bpm

CLINICAL PEARLS

The Latest in Cardiometabolic-Related Guidelines and Clinical Pearls

Obesity andLifestyle

Managementin CVD

www.cardiometabolichealth.org

American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity © 2016

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2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society

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Pharmacologic Management of Obesity: An Endocrine Society Clinical Practice Guideline

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Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

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• To diagnose overweight and obese patients:

- Do NOT rely on body mass index (BMI) alone

- Assess risk factors like waist circumference (WC)

- Use ethnic-specific criteria

• For each individual patient:

- Use proper language and motivational interviewing when initiating conversation for weight-loss

- Develop complications-focused, not BMI-focused, weight management treatment plans, based on current guidelines

- Use medications for chronic weight management appropriately to help more patients achieve the health benefits of weight loss

CLINICAL PEARLS

Dyslipidemia, Atherosclerosis, and CVD Risk

Reduction

www.cardiometabolichealth.org

2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents

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2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk

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National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia NLA Recommendations for Patient-Centered Management of

Dyslipidemia: Part 1-Full Report

PDF Link

NLA Recommendations for Patient-Centered Management of Dyslipidemia: Part 2

PDF Link

NLA Updated Recommendations on the Use of PCSK9 Inhibitors

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American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease

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The Latest in Cardiometabolic-Related Guidelines and Clinical Pearls

• Evidence-based statin therapy of appropriate intensity is recommended in all 4 statin benefit groups

• Statin intolerance: - True statin intolerance is uncommon - Individuals may experience unacceptable adverse

effects when taking the recommended intensity of statin, the most commonly reported being muscle-related symptoms

- Systematic approach to evaluation of statin-related adverse effects is critically important to encourage adherence to evidence-based statin treatment

- ACC Statin Intolerance Tool can be used to address potential statin intolerance

• 2017 Expert Consensus Decision Pathway (ECDP) - Includes considerations based on RCT data

with PCSK9 inhibitors: evolocumab (FOURIER), alirocumab (ODYSSEY)

- New data did not warrant changes to algorithms regarding the use of ezetimibe or PCSK9 inhibitors in:

- Primary prevention patients with LDL-C <190 mg/dL with or without diabetes mellitus

- Patients without ASCVD and LDL-C >190 mg/dL not due to secondary causes

• Do not forget the opportunity to improve diet, exercise and control other risk factors to reduce overall risk for CV events even if patients are not able to tolerate any lipid lowering medications

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