Reducing Vascular Risk

Does This Patient Require Vascular Protective Medication?

To be used for vascular protection, even if the baseline blood pressure or LDL-C is at target

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Does the patient have clinical cardiovascular disease?

  • Angina; previous MI; previous PTCI; previous CABG
  • Peripheral artery disease: claudication, peripheral bypass
  • Cerebrovascular disease: TIA, CVA
Yes No

Does the patient have type 2 diabetes?

Yes No

Is the patient's A1C above target?

Yes No

Does the patient have clinical microvascular disease?

  • Retinopathy
  • Nephropathy: elevated ACR, reduced eGFR
  • Neuropathy
Yes No

What is the patient's age?

  yearsSubmit

How long has the patient been diagnosed with diabetes?

  yearsSubmit

Does the patient have at least one of the following risk factor for cardiovascular disease?

  • Total cholesterol >5.2 mmol/L
  • HDL-C <0.9 mmol/L
  • Hypertension
  • Albuminuria
  • Smoking
Yes No
Get Recommendation
Get Recommendation
DRUG CLASS RECOMMENDATION CAUTIONS

Statin

YES

Potentially embryopathic – discontinue prior to conception.
Try to achieve targets in Canadian Cardiovascular Society guidelines, prescribe up to maximally tolerated and approved dose.

ACEi / ARB

YES

Potentially embryopathic – discontinue prior to conception (used to treat hypertension) or upon detection of pregnancy (used to treat CKD).
Caution if hypotensive. Prescribe at doses with demonstrated vascular protection.

ASA

YES

 

Liraglutide, Empagliflozin or Canagliflozin

YES

No safety data – discontinue prior to conception.
Prescribe at doses with demonstrated vascular protection. Go to Pharmacotherapy for Type 2 Diabetes for more details.

DRUG CLASS RECOMMENDATION CAUTIONS

Statin

YES

Potentially embryopathic – discontinue prior to conception.
Try to achieve targets in Canadian Cardiovascular Society guidelines, prescribe up to maximally tolerated and approved dose.

ACEi / ARB

YES

Potentially embryopathic – discontinue prior to conception (used to treat hypertension) or upon detection of pregnancy (used to treat CKD).
Caution if hypotensive. Prescribe at doses with demonstrated vascular protection.

ASA

YES

 

DRUG CLASS RECOMMENDATION CAUTIONS

Statin

YES

Potentially embryopathic – discontinue prior to conception.
Try to achieve targets in Canadian Cardiovascular Society guidelines, prescribe up to maximally tolerated and approved dose.

ACEi / ARB

YES

Potentially embryopathic – discontinue prior to conception (used to treat hypertension) or upon detection of pregnancy (used to treat CKD).
Caution if hypotensive. Prescribe at doses with demonstrated vascular protection.

ASA

Not routinely recommended

 

DRUG CLASS RECOMMENDATION CAUTIONS

Statin

YES

Potentially embryopathic – discontinue prior to conception.
Try to achieve targets in Canadian Cardiovascular Society guidelines, prescribe up to maximally tolerated and approved dose.

ACEi / ARB

NO

May be indicated for BP control

 

ASA

Not routinely recommended

 

DRUG CLASS RECOMMENDATION CAUTIONS

Statin

NO

May be indicated per CCS guidelines

 

ACEi / ARB

NO

May be indicated for BP control

 

ASA

Not routinely recommended

 

Next step: download and complete a Prescription for Cardiovascular Protection with Diabetes

Prescription for Cardiovascular Protection with Diabetes:Download PDF

Risk Assessment Algorithm:Download PDF

Additional Resources: Canadian Cardiovascular Society (CCS) Guideline Resources

This is only to be used as a decision support tool and is subject to these terms.
For more information, please see terms of use.

*The Canadian Diabetes Association is the registered owner of the name Diabetes Canada. All content on guidelines.diabetes.ca, CPG Apps and in our online store remains exactly the same. For questions, contact communication@diabetes.ca.