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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▼ Risk Assessment

▼ Recommended vascular protective medication

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

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