According to available evidence, which of the following is a treatment strategy for the delay or prevention of macrovascular complications?
Answer: 6. All of the above
All of these factors contribute to the prevention or delay of macrovascular complications. Studies (Action to Control Cardiovascular Risk in Diabetes [ACCORD], Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation [ADVANCE] and Veteran Affairs Diabetes Trial [VADT]) have found glycemic control (as measured by A1C) is an important component in the prevention of microvascular complications. In addition, for most non-pregnant adults, glycemic control (A1C ? 7%) early in the diabetes disease course has been associated with a reduction in macrovascular complications. Diabetes is considered to be a risk factor for atherosclerosis, independent of other cardiovascular risk factors such as hypertension, dyslipidemia and smoking. It has been suggested that in a diabetic state, insulin induces pathogenetic changes such as: increased synthesis of atherogenic factors (endothelin and plasminogen activator inhibitor), increased expression of insulin-like growth factor-1 and insulin induced stimulation of vascular endothelial and smooth muscle cells. Other risk factors should be addressed as they apply to individual patients. Current recommendations are:
- Blood Pressure < 130/80 mmHg
- Total Cholesterol <200
- LDL < 100 and < 70 for those with diabetes and heart disease
- HDL: Men: Above 45; Women: Above 55
- TG < 150
- Smoking cessation
- Low-dose aspirin (75-162 mg/day) for diabetes patients with increased cardiovascular risk.