Cardiovascular risk factors

The ADA’s update takes a less aggressive position on antiplatelet therapy than earlier versions, advocating daily aspirin (75-162 mg) as primary prevention only for individuals at increased risk of CVD: men older than age 50 years or women older than age 60 years with at least one additional major risk factor (hypertension, smoking, dyslipidemia, or family history of CVD).

Pharmacotherapy for hypertension (>130/80 mm Hg even after three months of lifestyle therapy) should include an ACE inhibitor or angiotensin II receptor blocker; usually, multiple medications are needed.

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The ADA guidelines recommend LDL levels below 100 mg/dL. Other lipid parameters are not as crucial, but HDL levels above 40 mg/dL for men and 50 mg/dL for women are “desirable,” as are triglycerides under 150 mg/dL.

Statins, the drug therapy of choice to lower LDL, are also beneficial for many patients with diabetes whose lipids are normal. The ADA guidelines recommend statin therapy for those with overt CVD and for those older than age 40 years who have one or more CVD risk factors, regardless of baseline cholesterol.

The American Diabetes Association’s Standards of Medical Care in Diabetes—2010, an executive summary of the Standards, and other related documents are available online (accessed December 15, 2010).

Mr. Sherman is a freelance medical writer in New York City.