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New Guidelines from the American Diabetes Association

The American Diabetes Association (ADA) is recommending a less stringent diastolic blood pressure target for people with diabetes and that all people with diabetes take either moderate or high doses of statins, in keeping with recent changes to guidelines for cardiovascular risk management enacted by the American College of Cardiology (ACC) and American Heart Association (AHA). These recommendations are reflected in the most recent changes to the Association’s annual revised Standards of Medical Care, being published in a special supplement to the January 2015 issue of Diabetes Care.

A release from ADA notes that the new Standards of Medical Care are updated annually to provide the best possible guidance to health care professionals for diagnosing and treating adults and children with all forms of diabetes. The Standards are based upon the most current scientific evidence, which is rigorously reviewed by the Association’s multi-disciplinary Professional Practice Committee.

Last year, the ACC and AHA jointly issued new recommendations for cardiovascular risk management that set up a decision tree to determine when to prescribe the use of cholesterol-lowering drugs, called statins, that would have placed the vast majority of people with diabetes under this therapy. Until now, the Association has not issued a response to these guidelines and their appropriateness for people with diabetes, who are two to four times as likely as people without diabetes to have a heart attack or stroke. Cardiovascular disease is the number one killer of people with diabetes.

Because people with diabetes are already at high risk for heart disease, the revised Standards of Medical Care call for all people with diabetes to take statins, said Richard W. Grant, MD, MPH, Research Scientist, Kaiser Permanente Division of Research and Chair of the Association’s Professional Practice Committee. They recommend people with diabetes who are under 40 years of age, or who are between the ages of 40 and 75 with no additional cardiovascular disease risk factors, take a moderate-intensity statin, while those of all ages who have cardiovascular disease, or those ages 40-75 who have additional cardiovascular risk factors, take a high-intensity statin.

The release quotes Grant as saying, “The big change here is to recommend starting either moderate or high-intensity statins based on the patient’s risk profile rather than on LDL level. Since all patients with diabetes are at increased risk, it is just a matter of deciding whom to start on moderate versus high-intensity statin doses.”

The revised recommendations also call for a less stringent diastolic blood pressure goal for people with diabetes of 90 mmHg, up from 80 mmHg.

“While observational studies find that lower blood pressure generally seems to be better, the higher quality randomized trial evidence most strongly supports the treatment target of 90 mmHg,” Grant said.