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Am Fam Physician. 2006;73(4):730

The National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) have released a report that identifies ways to improve prevention and treatment of cardiovascular disease (CVD) in persons with type 1 diabetes. According to the report, CVD is the main cause of morbidity and mortality in patients with type 1 and type 2 diabetes, but most investigations of diabetes and macrovascular CVD have addressed type 2 disease only. The NHLBI/NIDDK report appears in the June 28, 2005, issue of Circulation.

The authors suggest there are at least four potentially effective interventions to prevent coronary artery disease in persons with type 1 diabetes: control of hyperglycemia, control of hypertension, control of dyslipidemia, and control of insulin resistance. With the use of insulin analogues and pumps, A1C levels can be lowered safely below 7 percent in many adults with type 1 diabetes. Blood pressure should be lowered to a target of less than 130/80 mm Hg to improve kidney function and slow the progression of microalbuminuria (a risk factor for coronary artery disease). Tight control should be maintained over low-density lipoprotein (LDL) cholesterol levels, with a target level of less than 100 mg per dL (2.60 mmol per L), and an optional goal of less than 70 mg per dL (1.80 mmol per L) for persons with diabetes and CVD. Pharmacotherapy is recommended for patients with diabetes whose LDL cholesterol level is 100 mg per dL or higher. Insulin resistance can be reduced with optimal insulin therapy, increased physical activity, weight control, and (rarely) insulin-sensitizing medications.

The NHLBI/NIDDK report also notes that physicians are increasingly prescribing aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins to younger patients and those at high risk of developing CVD. Risk factor patterns need to be investigated further, the report states, and strategies should be considered for primary, secondary, and tertiary prevention of coronary artery disease in patients with type 1 diabetes.

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Copyright © 2006 by the American Academy of Family Physicians.

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