ADA心血管疾病与风险管理：糖尿病的医疗护理标准(2022年)

1、10.Cardiovascular Disease andRisk Management:Standards ofMedical Care in Diabetes2022Diabetes Care 2022;45(Suppl.1):S144S174|https:/doi.org/10.2337/dc22-S010American Diabetes AssociationProfessional Practice Committee*The American Diabetes Association(ADA)“Standards of Medical Care in Diabetes”includes the ADAs current clinical practice recommendations and is intended to pro-vide the components of diabetes care,general treatment goals and guidelines,andtools to evaluate quality of care.Members o

2、f the ADA Professional Practice Commit-tee,a multidisciplinary expert committee(https:/doi.org/10.2337/dc22-SPPC),areresponsible for updating the Standards of Care annually,or more frequently as war-ranted.Fora detailed description of ADA standards,statements,and reports,as wellas the evidence-grading system for ADAs clinical practice recommendations,pleaserefer to the Standards of Care Introduction(https:/doi.org/10.2337/dc22-SINT).Readers who wish to comment on the Standards of Care are invite

3、d to do so atprofessional.diabetes.org/SOC.For prevention and management of diabetes complications in children and adoles-cents,please refer to Section 14,“Children and Adolescents”(https:/doi.org/10.2337/dc22-S014).Atherosclerotic cardiovascular disease(ASCVD)defined as coronary heart disease(CHD),cerebrovascular disease,or peripheral arterial disease presumed to be ofatherosclerotic originis the leading cause of morbidity and mortality for individu-als with diabetes and results in an estimated

4、$37.3 billion in cardiovascular-relatedspending per year associated with diabetes(1).Common conditions coexisting withtype 2 diabetes(e.g.,hypertension and dyslipidemia)are clear risk factors forASCVD,and diabetes itself confers independent risk.Numerous studies have shownthe efficacy of controlling individual cardiovascular risk factors in preventing orslowing ASCVD in people with diabetes.Furthermore,large benefits are seen whenmultiple cardiovascular risk factors are addressed simultaneously.

5、Under the cur-rent paradigm of aggressive risk factor modification in patients with diabetes,thereis evidence that measures of 10-year coronary heart disease(CHD)risk among U.S.adults with diabetes have improved significantly over the past decade(2)and thatASCVD morbidity and mortality have decreased(3,4).Heart failure is another major cause of morbidity and mortality from cardio-vascular disease.Recent studies have found that rates of incident heart failurehospitalization(adjusted for age and s

6、ex)were twofold higher in patients withdiabetes compared with those without(5,6).People with diabetes may haveheart failure with preserved ejection fraction(HFpEF)or with reduced ejectionfraction(HFrEF).Hypertension is often a precursor of heart failure of eithertype,and ASCVD can coexist with either type(7),whereas prior myocardialinfarction(MI)is often a major factor in HFrEF.Rates of heart failure hospitali-zation have been improved in recent trials including patients with type 2*A complete l

7、ist of members of the AmericanDiabetes Association Professional Practice Com-mittee can be found at https:/doi.org/10.2337/dc22-SPPC.This section has received endorsement from theAmerican College of Cardiology.Suggested citation:American Diabetes Asso-ciation Professional Practice Committee.10.Cardiovascular disease and risk management:Standards of Medical Care in Diabetes2022.Diabetes Care 2022;45(Suppl.1):S144S174 2021 by the American Diabetes Association.Readers may use this article as long a

8、s thework is properly cited,the use is educationaland not for profit,and the work is not altered.Moreinformationisavailableathttps:/diabetesjournals.org/journals/pages/license.10.CARDIOVASCULAR DISEASE AND RISK MANAGEMENTS144Diabetes Care Volume 45,Supplement 1,January 2022Downloaded from http:/diabetesjournals.org/care/article-pdf/45/Supplement_1/S144/670349/dc22s010.pdf by guest on 10 July 2022diabetes,most of whom also hadASCVD,with sodiumglucose cotrans-porter 2(SGLT2)inhibitors(810).For pre

9、vention and management ofboth ASCVD and heart failure,cardiovas-cular risk factors should be systematicallyassessed at least annually in all patientswith diabetes.These risk factors includeduration of diabetes,obesity/overweight,hypertension,dyslipidemia,smoking,afamily history of premature coronary dis-ease,chronic kidney disease,and thepresenceofalbuminuria.Modifiableabnormal risk factors should be treatedas described in these guidelines.Notably,the majority of evidence supporting inter-ventio

10、ns to reduce cardiovascular risk indiabetes comes from trials of patientswith type 2 diabetes.Few trials havebeen specifically designed to assess theimpact of cardiovascular risk reductionstrategies in patients with type 1 diabetes.As depicted in Fig.10.1,a comprehen-sive approach to the reduction in risk ofdiabetes-related complications is recom-mended.Therapy that includes multiple,concurrent evidence-based approachestocarewillprovidecomplementaryreduction in the risks of microvascular,kidney,

《ADA心血管疾病与风险管理：糖尿病的医疗护理标准(2022年)》由会员宜***分享，可在线阅读，更多相关《ADA心血管疾病与风险管理：糖尿病的医疗护理标准(2022年)》请在金锄头文库上搜索。