for younger motivated patients, but generally this will require either |
100 % |
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major lifestyle change, significant |
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|
weight loss and / or intensive pharmacotherapy. Although intrinsically beneficial in the long term, it is unclear if normalisation of glucose control( on its own) can also reduce CVD risk beyond standard of care.
Lipid-lowering therapy
Guidelines recommend that all
patients with T2DM at high CVD risk should be treated with high-intensity statin therapy at the highest dose tolerated by that individual
24, 25
( see table 1).
Treatment with high-intensity statins should be initiated in all patients with T2DM at high CVD risk regardless of their baseline blood lipid levels, as statins will reduce the relative CVD risk, in proportion to LDL cholesterol( LDL-C) lowering. Despite widespread misinformation, statins unequivocally remain the single most powerful strat-
|
Percentage of patients with type 2 diabetes(%) |
90 %
80 %
70 %
60 %
50 %
40 %
30 %
20 %
10 %
|
Established CVD |
Secondary prevention
Primary prevention
|
High or very high risk
Moderate risk
|
egy to lower CVD risk in patients with T2DM. 36 For example, in a meta-analysis of participants with |
0 % |
Low risk |
T2DM without CVD, statins reduced the risk of MACE by 25 %( relative |
Figure 4. Distribution of cardiovascular risk. |
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