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Diabetes mellitus
Coronary risk assessment, why and how
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Principle: All people with diabetes should have an assessment of their
coronary risk status at least once every five years.
Assessing an individual's overall coronary risk is now an important component
of decision making for a variety of interventions in people with diabetes.
These are:
- Decision to recommend aspirin.
- When to treat hypertension (in patient with
renal disease please see renal protocol)
- When to use lipid lowering drugs e.g. statins.
It can also be used when discussing with patient risks and benefits for a
wide variety of drugs and non-drug intervention.
Why?
- An individual's overall risk is determined by a wide variety of factors
working together.
- High risk patients benefit most from all effective interventions and this
includes smoking cessation, healthy eating, exercise as well as drug
therapy.
Targets
- To calculate and record absolute coronary risk in all patients at least
once every five years.
- To offer counselling and advice about possible interventions in all
patients in whom the risk >30% over 10 years
Benefits
- Morbidity and mortality from coronary disease can be reduced through
intervention
- Knowledge of risk may motivate some patients to improve lifestyle
Risks
- There is a balance to be struck between helping patients understand the
seriousness of risk without making them so frightened that they are unable
to address it.
Suggested action
- Use Joint
Societies risk tables to calculate the 10 year risk of a cardiac
event
- 'For risk, Check six': age, gender, presence of diabetes, smoking
status, systolic blood pressure and total to HDL cholesterol ratio
- Remember that if the patient has microalbuminuria, central obesity, left
ventricular hypertrophy, family history of premature coronary disease,
established coronary disease or is of South Asian origin then the risk is
increased. One factor doubles the risk and two or more factors treble the
risk
- If risk is > 30 % per IA) years, then discuss this with the patient.
Talk about absolute risk and when possible talk about absolute (rather than
relative) risk reduction achievable through intervention
- Review modifiable risk factors and agree on action with the patient
- Record targets according to guidelines and patient preferences
- Agree with the patient a 3-6 month plan for risk factor modification
Source: Northumbria NHS Health Care Trust diabetes protocol