Managing Arterial Risk Factors

Integrated management of arterial risk

Arterial damage is the major cause of death and disability in people with Type 2 diabetes

Review arterial risk factors :

blood glucose

blood lipids

blood preassure

smoking

body weight / abdominal adiposity

family history

albumin excretion rate

arterial / heart symptoms

at diagnosis

yearly

more frequently if abnormal or treated

Define risk level as :

	Average risk :	any one arterial risk factor
or	High risk :	established disease, or any two arterial risk factors
or	Very high risk :	established disease + any arterial risk factor
		or any three arterial risk factors

Manage as follows :

if	High risk :	manage blood glucose, blood lipids, blood pressure to assessment levels
if	Very high risk :	manage blood glucose, blood lipids, blood pressure to lowest possible risk levels
if	Smoking :	manage problem aggressively ( see also : Smoking target )

Educate people :

about the risks of heart disease / stroke from the time of diagnosis

about not smoking and smoking cessation programmes ( see also : Smoking target )

about healthy eating ( see also : Healthy eating )

Prescribe :

a programme of regular physical exercise ( see also : Physical Exercise )

glucose, lipid, and blood pressure lowering therapy as indicated

low-dose aspirin for those in the High risk or Very high risk categories

selective ß-adrenergic blockers if known ischaemic heart disease

Consider :

hormone replacement therapy post-menopausally ( if agreed )

Diagnose :

silent myocardial ischaemia in higher risk patients ( see also : Ischaemic Heart Disease )