Screening for CVD:What You Need to Know

James A. StoneBPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC

Clinical ProfessorCumming School of Medicine, University of CalgaryLibin Cardiovascular Institute of Alberta

Senior Medical DirectorCardiovascular Health and Stroke Strategic Clinical NetworkAlberta Health Services

Screening for CVD:What You Need to Know

Learning Objectives

Following This Session, Participants Will Be Able To:

1.Review Key Elements of CVD Screening

2.CVD Event Prevention and Management

CVD Assessment and Event Risk Prediction

Screening For:

• CVD/Atherosclerosis• CVD Event Risk

Challenge

• Individualized Proximate Event Prediction• Very Difficult

CVD Screening

CVD Event Risk in DM: Sex Influence

Booth GL, et al. Lancet 2006;368:29-36.

Screening for the Presence of Cardiovascular DiseaseChapter 24Paul Poirier MD PhD FRCPC FACC FAHA, FCCS, Olivier F. Bertrand MD PhD, Jonathon Leipsic MD FRCPC, G. B. John Mancini MD FRCPC FACP FSCCT, Paolo Raggi MD FACC FAHA FACP FASNC FSCCT, André Roussin MD FRCPC

2018 Clinical Practice Guidelines

Who Should have Stress Testing and/or Functional Imaging to Screen for CAD?

Typical or atypical cardiac symptoms

Associated diseases:– PAD– Carotid bruits– TIA– Stroke

Resting ECG abnormalities

(e.g. Q waves)

Exercise ECG Stress Testing

Cannot exercise or resting ECG

abnormality:

– Pharmacologic Stress:– Nuclear– Echo– MR– CT30% -50% Abnormal

Who Needs a Referral to a Cardiac Specialist?

Heart Failure

Typical Angina

Severe Ischemia

Low Exercise Capacity

Cardiovascular Protection in People with DiabetesChapter 23James A. Stone MD PhD FRCPC, Robyn L. Houlden MD FRCPC, Peter Lin MD CCFP, Jacob A. Udell MD MPH FRCPC, Subodh Verma MD PhD FRCSC

2018 Clinical Practice Guidelines

1. Treat Diabetes2. Treat Hypertension3. Treat Lipids4. Treat Mental Health5. Treat Inactivity6. Treat Nutrition7. Treat Smoking8. Treat Weight

Simultaneously!

CVD Event Prevention and Management

Vascular Protection ChecklistABCDEs

A • A1C – optimal glycemic control (usually ≤7%)

B • BP – optimal blood pressure control (<130/80)

C • Cholesterol – LDL-C < 2.0 mmol/L or >50%

reduction if treatment indicated

D • Drugs to protect the heartA – ACEi or ARB │ S – Statin │ A – ASA if indicated │SGLT2i / GLP-1RA with

demonstrated CV benefit if type 2 DM with CVD and A1C not at target

E • Exercise / Healthy Eating

S • Smoking cessation

Cardiovascular Protection in People with Diabetes

And

• Diabetes!!!

• SCEXAPABETASTATIRAAIDDD• SGLT-2 Inhibitors• GLP-1 Receptor Agonists

Summary• Higher risk of developing CVD:

• Women• Earlier Age

• No symptoms does NOT Mean:• No Disease• No Problems

Summary• Symptomatic Individuals with DM

• Exercise Stress Testing May Be Useful

• Cardiac Stress Imaging

• Asymptomatic High Proximate CVD Risk:

• CT Coronary Angiography

• Coronary Artery Calcium Scoring

Summary

• SCEXAPABETASTATIRAAIDDD• SGLT-2 Inhibitors• GLP-1 Receptor Agonists