2023-12-07 13:28:04
Diabetes is associated with a proven excess cardiovascular risk (multiplication by 2 to 4). But diabetic patients who have already diagnosed CV pathology or complications (target organ damage) benefit from molecules with cardiovascular benefits (iSGLT2 and aGLP-1), the other patients are always treated with metformin as first line, according to the latest receipts from the Francophone Diabetes Society (2023).
New in the 2023 ESC recos: a Systematic assessment of CV risk is recommended in all diabetics between 40 and 69 years old, even in the absence of established atheromatous disease or complications. The goal is to better personalize care to refine primary CV prevention in these patients.
This evaluation, made using a new tool, SCORE2 -Diabetes (available for free in the ESC CVD Risk Calculation App, to download herecf. framed), makes it possible to identify the probabilities of occurrence of a CV event within 10 years (patients already having atheromatous disease or severe target organ damage, automatically classified as very high risk, are not affected by this score). The risk is considered low for a result < 5%, moderate between 5 to < 10%, high between 10 and 20% and very high if ≥ 20%.
For high-risk patients (score between 10% and 19%)the ESC recommends:
For patients at very high risk (SCORE2 -Diabetes ≥ 20%):
a target of LCL-c < 0,55 g/L et une cible secondaire de cholestérol non-HDL-c < 0,85 g/L ; si la cible n’est pas atteinte avec un traitement par statines à haute intensité, une association avec l’ézétimibe voire avec un anti-PCSK9 is recommended (class I, A and B);iSGLT2 and/or GLP-1or metformin and/or SGLT2 and/or GLP-1 can be considered (class IIb, C).
Usual health and diet recommendations continue to apply, of course.
Reciprocallythe ESC insists on the necessary diabetes screening in patients with CV diseaseby fasting blood sugar or HbA1c measurement (grade A).
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