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GUIDELINE
ADA updates recommendations on diabetes & CKD
The American Diabetes Association (ADA) has updated its diabetes standards of care to incorporate results from the CREDENCE trial, published in the New England Journal of Medicine.
In the placebo-controlled trial, the sodiumglucose cotransporter-2 (SGLT2) inhibitor canagliflozin was associated with reduced risk for cardiovascular events and renal failure in patients with type 2 diabetes and chronic kidney disease (CKD).
Among the updates:
• Urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate (eGFR) should be assessed at least annually in all patients with type 2 diabetes.
• For patients with type 2 diabetes and diabetic kidney disease, clinicians should consider using an SGLT2 inhibitor when the eGFR is at or above 30, especially with albuminuria above 300 mg/g, to lower renal and CV risk.
• For patients with CKD at elevated risk for CV events, a glucagon-like peptide 1 receptor agonist may lower risk for albuminuria progression and/ or CV events.
The update reads: “Although the adverse event profiles of these agents must be considered, the risk-benefit balance of SGLT-2 inhibitor treatment appears to be favourable for most patients with type 2 diabetes and CKD."
AHA offers CVD guidance for patients with HIV
The American Heart Association (AHA) offers new guidance in preventing and managing cardiovascular disease in patients with HIV. Here are some of the group's recommendations, published in Circulation:
• Patients with HIV should have their risk for atherosclerotic cardiovascular disease (ASCVD) assessed with the ACC/AHA ASCVD Risk Estimator or an alternative calculator.
• If any of the following risk factors are present, a person's CVD risk may be higher than the calculated ASCVD risk: hepatitis C coinfection; metabolic syndrome, lipodystrophy/lipoatrophy, or fatty liver disease; HIV treatment failure/nonadherence; low CD4 count (less than 350 cells/ mm3); or a history of prolonged HIV viraemia or delayed initiation of antiretroviral therapy (ART).
• Simvastatin and lovastatin should be avoided. Pravastatin and pitavastatin are the least likely statins to interfere with antiretroviral therapy. Atorvastatin and rosuvastatin may also be considered.
Dr. Carlos del Rio, an editor with NEJM Journal Watch Infectious Diseases, comments: “With effective antiretroviral therapy, people living with HIV (PLWH) can live near normal lives but they are at increased risk of comorbid conditions including cardiovascular diseases.