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National evidence-based guideline on secondary prevention of cardiovascular disease in type 2 diabetes
Piterman L, Grenfell R, Clifton P, Peter K, Cheung W, Reid C, Maple-Brown L, Buckley E, Morona J, Juneja V, Mnatzaganian G, Lehman S, Docter S, Reddin E, Tamblyn D, Ellery B, Merlin T, Ko H, Sooriyakumaran M, Huo L, Willson M, Misso M [Baker IDI Heart and Diabetes Institute]
practice guideline

The prevalence of type 2 diabetes is rapidly rising. This has major public health implications as type 2 diabetes is a major risk factor for the development of atherosclerosis of the major vessels. Most disability and premature mortality experienced by people with diabetes is related to cardiovascular disease. Indeed in 2010 in those aged 20 to 79 years around 5 million deaths globally were attributable to diabetes with 50% of these deaths attributable to cardiovascular disease. This guideline addresses the management of adults with type 2 diabetes, in relation to the prevention of recurrence of cardiovascular events. The focus is on individuals already known to have symptomatic cardiovascular disease (eg, prior myocardial infarction or stroke). This is a particularly high risk population, and therefore merits careful attention in clinical practice. The guideline is aimed mainly at primary care, and therefore does not provide advice on in-patient management (such as coronary artery stenting or surgery). The major modifiable risk factors for the development of cardiovascular events are blood pressure, lipid levels and platelet function. This guideline addresses the main pharmacological approaches to controlling these risk factors. Lifestyle interventions are also important, but the levels of evidence for such interventions are generally lower, and they are comprehensively discussed elsewhere. The guideline generally promotes an aggressive approach to management of risk factors, in recognition of the high risk of the target population. Nevertheless, it also advises caution in regard to contra-indications and adverse events, particularly in the elderly. It is important that management strategies are individualised to each patient, and the recommendations contained in this guideline are understood as just recommendations.

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