Atherosclerotic cardiovascular disease (ASCVD) is one of the major causes of morbidity and mortality in people with diabetes, and there are now multiple ways to reduce the incidence of ASCVD events. A panel discussion, Screening and Primary Prevention Strategies for ASCVD in Diabetes, on Friday, June 20, from 3:45–5:15 p.m., in Room W184 A–D of the McCormick Place Convention Center, will focus on the prevention of ASCVD in this high-risk population.

“Blood pressure is one of the key therapeutic targets for individuals at risk of ASCVD events, along with glucose control,” said Ian H. de Boer, MD, MS, Professor of Medicine-Nephrology, and the Joseph W. Eschbach, MD, Endowed Chair in Kidney Research at the University of Washington, and Director of the Kidney Research Institute. “Blood pressure is one of the few validated surrogate outcomes in ASCVD and is causally related to ASCVD and heart failure. Many of the drugs that lower blood pressure also prevent ASCVD.”

Dr. de Boer will explore blood pressure targets in primary prevention of cardiovascular disease in diabetes.

“One of the critical questions in clinical practice is the optimal blood pressure target for individual patients and how best to titrate therapies and other interventions to help patients achieve their blood pressure targets,” he said. “Over decades, 140/90 has been a well-rationalized and established blood pressure target.”

However, the clinical benefit of more intensive approaches, aimed at lower blood pressure thresholds, is controversial, especially considering more recent and conflicting evidence, noted Dr. de Boer, who will review seminal studies addressing this question, including the ACCORD, SPRINT, and BPROAD clinical studies.

“The BPROAD study, a landmark study out of China, helps resolve much of the confusion and uncertainty around blood pressure targets in people with type 2 diabetes,” he said.

Dr. de Boer will also discuss practical, evidence-based recommendations on how to measure blood pressure, individualize targets, and develop treatment plans that can help patients achieve their blood pressure targets.

“With new evidence, lower blood pressure is better at reducing ASCVD risk and we can more confidently recommend blood pressure targets,” he said. “The individualization of blood pressure targets, however, has not been elucidated clearly or publicized by guidelines. I will suggest approaches for tailoring blood pressure targets, based primarily on treatment tolerability and aimed at mitigating adverse effects associated with antihypertensive drugs.”

Matthew Budoff, MD, Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), and Investigator at the Lundquist Institute at Harbor-UCLA, will speak about when and how to screen for ASCVD, and the role of coronary calcium scans in risk stratification.

“There is substantial evidence showing that patients with type 2 diabetes are not homogeneous with respect to the calcified plaque deposits in their arteries and their risk of coronary events,” Dr. Budoff said. “Coronary calcium scans are a validated stratification tool incorporated into several guidelines. Moreover, this approach for assessing coronary artery calcification (CAC) has recently been included as a service within health care insurance policies for patients with diabetes.”

Dr. Budoff will review epidemiological and outcomes data associated with coronary calcium scores in people with type 2 diabetes. He will also discuss data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) trials in people with type 1 diabetes and CAC score-based risk stratification.

“I think there is a move to expand coronary calcium scanning to help us further stratify risk in patients with diabetes, given the range of new therapies now available,” Dr. Budoff said. “In a population of patients with type 2 diabetes, not all will be eligible to receive glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose cotransporter-2 (SGLT2) inhibitors based on current algorithms. However, a high CAC score may help identify high-risk patients with diabetes who can benefit from primary prevention approaches.”

The panel discussion will also feature presentations by:

• David Aguilar, MD, Professor of Medicine at the University of Texas Southwestern Medical Center, on the role of aspirin for primary prevention of cardiovascular disease in diabetes
• Carol Mangione, MD, MSPH, FACP, Professor of Medicine and Public Health at UCLA, on screening for lipid disorders
• Cecilia C. Low Wang, MD, FACP, Professor of Medicine at the University of Colorado Anschutz Medical Campus, exploring the role of glucose-lowering drugs

On-demand access to recorded presentations will be available to registered participants following the conclusion of the 85^th Scientific Sessions, from June 25–August 25.