- Symbols and Abbreviations
- Classes of recommendations and levels of evidence
- Amendments and Updates
- Chapter 1.1 Hypertension
- Chapter 1.2 Dyslipidaemia
- Chapter 1.3 Metabolic syndrome and diabetes
- Chapter 1.4 Thrombosis
- Chapter 2.1 Acute coronary syndrome: STEMI and NSTEMI
- Chapter 2.2 Chronic stable angina
- Chapter 2.3 Coronary artery spasm and microvascular angina
- Chapter 2.4 Takotsubo syndrome
- Chapter 3.1 Heart failure
- Chapter 3.2 Heart transplantation
- Chapter 4.1 Atrial fibrillation
- Chapter 4.2 Supraventricular (narrow complex) tachycardias
- Chapter 4.3 Ventricular arrhythmias
- Chapter 4.4 Bradyarrhythmias
- Chapter 4.5 Syncope
- Chapter 5.1 Valvular heart disease
- Chapter 5.2 Myocarditis and pericardial syndromes
- Chapter 5.3 Cardiomyopathy
- Chapter 5.4 Pulmonary hypertension
- Chapter 6.1 Kidney disease
- Chapter 6.2 Pregnancy and lactation
- Chapter 6.3 Liver disease
- Chapter 7.1 Major drug interactions
- Chapter 8.1 Cardiovascular drugs—from A to Z
- Chapter 9.1 Non-cardiac drugs affecting the heart—from A to Z
(p. 49) Metabolic syndrome and diabetes
- (p. 49) 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.
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