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Metabolic syndrome and diabetes 

Metabolic syndrome and diabetes
Metabolic syndrome and diabetes

Christoph H. Saely



The ESC in 2019 has published important new guidelines on diabetes, pre-diabetes, and cardiovascular diseases, as well as on lipid management.

The LDL-cholesterol goals for patients at very high risk, including the majority of patients with diabetes, have been lowered; now LDL-C lowering to <55 mg/dL plus at least a 50% reduction in LDL-C is recommended.

Also blood pressure treatment goals have been slightly modified. Antihypertensive drug treatment is recommended for people with diabetes when office blood pressure is >140/90 mmHg. In patients with diabetes, a target systolic blood pressure target of 130 mmHg and <130 mmHg, if tolerated, but not <120 mmHg, is recommended. In older people aged >65 years, the systolic blood pressure goal is 130–139 mmHg. The diastolic blood pressure target is <80 mmHg, but not <70 mmHg. It is recommended that patients with hypertension and diabetes are treated in an individualized manner.

According to current ESC guidelines, aspirin may also be considered in primary prevention patients with diabetes who are at high or very high risk; it is not recommended for primary prevention in diabetes patients at moderate risk.

Patients with early-onset T1DM of long duration (>20 years) now are allocated to the category of patients at very high risk of cardiovascular events.

Updated on 29 July 2020. The previous version of this content can be found here.
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date: 04 December 2021

The metabolic syndrome (MetS) and even more so diabetes confer a significantly increased risk of cardiovascular disease. A multifactorial approach is required to improve the prognosis of patients with the MetS or diabetes. Glucose control is essential to reduce microvascular diabetes complications and, over long periods of time, may also lower the risk of cardiovascular events in patients with diabetes. As in other patient populations, lowering low-density lipoprotein (LDL) cholesterol and treating arterial hypertension are paramount interventions to reduce cardiovascular event risk in patients with the MetS and diabetes. Most patients with diabetes must be considered at a very high risk of cardiovascular events, which qualifies them for low LDL cholesterol targets. Antiplatelet therapy is recommended for patients with the MetS or diabetes in secondary prevention; it may also be considered for primary prevention patients with diabetes who are at high or very high risk; it is not recommended for primary prevention in diabetes patients at moderate risk. Because the MetS or diabetes confers an extremely high risk of cardiovascular events once cardiovascular disease is established, it is extremely important to intervene early to prevent these patients from developing cardiovascular disease.

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