Thread by @claireyrivs

Catching @drsarahjdavies and @drnkan in the heart🫀and kidney clinic letting us know about reducing CV events

🧵 ⬇️ @UKCPADiabetes @UKCPACardiac @diabetespc #DPC22

CVD remains responsible for 24% of deaths in the UK

1 death every 3 minutes ⏱️

Range of modifiable and non-modifiable factors which can be discussed in clinic appointments

Individualised advice is 🔑

Biggest risk of having a CV event is having already had one!

Insulin resistance results in ⬆️ triglycerides

Triglycerides help identify adults treated with statins still at CV risk

Do we need to take fasting lipids? Evidence shows there is very little difference between fasting and non fasting results. Non-fasting nicer for pts

If triglycerides 5 or above then repeat fasted!

uACR - don’t need a morning urine sample @drsarahjdavies “any wee will do”

Thinking beyond statins and ezetimbe.

Icosapent ethyl vs placebo significant reduction in first, second, third and fourth events! REDUCE-IT trial

Generally well tolerated, few adverse events

NNT of 10 people with diabetes and CVD

Practicalities

Licensed indication in SPC differs to NICE TA - TA based on trial data (hence mention of fasting trigs)

Remember CV event does not just mean heart event! Can be a vascular event, don’t forget the V in CV

Dosing 2 BD : 998mg

No titration. Take with food as it is a pro drug, needs pancreatic enzymes to bring it to life 🧨

Try to move away from the fire and forget approach for lipid management, i.e add the drug and forget. Now know the risk of CV events remains despite statin or ezetimbe Tx

Now have more 💊 options available

Case studies
1. Make sure STATIN titrated to max tolerated dose. But trigs still high

Patient A - think about injectables 💉 - depending on service might need secondary care input

Patient B - consider orals, icosapent ethyl

Summary:

Trial data here: nejm.org/doi/full/10.10…