p.3 抽出テキスト
5.3.3.1. Metformin .................................................................................... 4069 5.3.3.2. Sulphonylureas ........................................................................... 4069 5.3.4. Special considerations ...................................................................... 4069 5.3.4.1. Hypoglycaemia and cardiovascular risk ........................... 4069 5.3.4.2. Effects on weight ....................................................................... 4070 5.3.5. Implications of results from cardiovascular outcomes trials of glucose-lowering medications .................................................. 4070 5.4. Blood pressure and diabetes ................................................................ 4072 5.4.1. Screening and diagnosis ................................................................... 4072 5.4.2. Treatment targets ............................................................................. 4072 5.4.3. Management of hypertension ....................................................... 4073 5.4.3.1. Effects of lifestyle intervention and weight loss ........... 4073 5.4.3.2. Pharmacological treatments in patients with diabetes 4074 5.4.3.3. Blood pressure changes with glucose-lowering agents 4074 5.4.4. Sex-specific aspects ........................................................................... 4074 5.5. Lipids and diabetes .................................................................................... 4075 5.5.1. Treatment targets ............................................................................. 4075 5.5.2. Lipid-lowering agents ....................................................................... 4075 5.5.2.1. Statins ............................................................................................. 4075 5.5.2.2. Ezetimibe ...................................................................................... 4075 5.5.2.3. Proprotein convertase subtilisin/kexin type 9 inhibitors ....................................................................................................... 4076 5.5.2.4. Fibrates and other TG-lowering drugs ............................ 4076 5.5.3. Novel cholesterol-lowering drugs .............................................. 4076 5.5.3.1. Inclisiran ......................................................................................... 4076 5.5.3.2. Bempedoic acid .......................................................................... 4076 5.6. Antithrombotic therapy and diabetes .............................................. 4077 5.6.1. Patients without a history of symptomatic atherosclerotic cardiovascular disease or revascularization ........................................ 4077 5.6.2. Patients with atherosclerotic cardiovascular disease and/ or revascularization without an indication for long-term oral anticoagulation ................................................................................................ 4078 5.6.2.1. Chronic coronary syndromes .............................................. 4078 5.6.2.2. Acute coronary syndrome .................................................... 4079 5.6.2.2.1. Peri-procedural management ...................................... 4079 5.6.2.2.2. Post-procedural management ..................................... 4079 5.6.2.2.3. Prolonging DAPT post-ACS ........................................ 4079 5.6.2.2.4. Shortening or de-escalating DAPT post-ACS in diabetes .................................................................................................... 4079 5.6.3. Patients with atherosclerotic cardiovascular disease and/or revascularization requiring long-term oral anticoagulation ....................................................................................... 4081 5.6.4. Preventing gastrointestinal bleeding .......................................... 4081 5.7. Multifactorial approach to risk-factor management in diabetes 4082 6. Management of coronary artery disease and diabetes ....................... 4083 6.1. Chronic coronary syndromes and diabetes .................................. 4083 6.1.1. Clinical presentation ......................................................................... 4083 6.1.2. Screening and diagnosis ................................................................... 4083 6.1.3. Management ......................................................................................... 4084 6.1.3.1. Pharmacotherapy ...................................................................... 4084 6.1.3.1.1. Glucose-lowering medication ..................................... 4084 6.1.3.1.2. Other medications ........................................................... 4084 6.1.3.2. Revascularization ....................................................................... 4084 6.2. Acute coronary syndromes and diabetes ....................................... 4084 6.2.1. Clinical presentation and diagnosis ............................................ 4084 6.2.2. Management ......................................................................................... 4085 6.2.2.1. Pharmacotherapy ...................................................................... 4085 6.2.2.2. Glucose control in patients with acute coronary syndrome ...................................................................................................... 4085 6.2.2.3. Reperfusion strategies in ST-elevation myocardial infarction ....................................................................................................... 4085 6.2.2.4. Optimal timing of invasive strategy in non-STelevation acute coronary syndrome ................................................. 4085 6.3. Ischaemia with no obstructive coronary artery disease in diabetes .................................................................................................................. 4086 7. Heart failure and diabetes ............................................................................... 4086 7.1. Definition and pathophysiology .......................................................... 4086 7.2. Epidemiology and prognosis ................................................................. 4086 7.3. Screening and diagnosis .......................................................................... 4087 7.4. Treatment of heart failure in patients with diabetes ................. 4088 7.4.1. Treatment of heart failure with reduced ejection fraction .............................................................................................. 4088 7.4.1.1. Sodium–glucose co-transporter-2 inhibitors ................ 4089 7.4.1.2. Angiotensin receptor–neprilysin inhibitor and angiotensin-converting enzyme inhibitors ...................................... 4089 7.4.1.3. Mineralocorticoid receptor antagonists .......................... 4089 7.4.1.4. Beta-blockers .............................................................................. 4089 7.4.1.5. Angiotensin-II receptor blockers ........................................ 4089 7.4.1.6. Ivabradine ..................................................................................... 4090 7.4.1.7. Hydralazine and isosorbide dinitrate ................................ 4090 7.4.1.8. Digoxin .......................................................................................... 4090 7.4.1.9. Diuretics ........................................................................................ 4090 7.4.1.10. Device therapy and surgery ............................................... 4090 7.4.2. Treatment of heart failure with mildly reduced ejection fraction ............................................................................................................... 4090 7.4.3. Treatment of heart failure with preserved ejection fraction ............................................................................................................... 4091 7.5. Safety profile of glucose-lowering agents in patients with heart failure and diabetes ............................................................................... 4091 7.5.1. Sodium–glucose co-transporter-2 inhibitors ......................... 4091 7.5.2. Glucagon-like peptide-1 receptor agonists ............................ 4092 7.5.3. Dipeptidyl peptidase-4 inhibitors ................................................ 4093 7.5.4. Insulin ...................................................................................................... 4093 7.5.5. Metformin ............................................................................................. 4093 7.5.6. Sulphonylureas .................................................................................... 4093 7.5.7. Thiazolidinediones ............................................................................. 4093 7.5.8. Special consideration: hypoglycaemia and risk of heart failure hospitalization .................................................................................... 4093 8. Arrhythmias: atrial fibrillation, ventricular arrhythmias, and sudden cardiac death and diabetes ................................................................................... 4096 8.1. Atrial fibrillation and diabetes .............................................................. 4096 8.1.1. Epidemiology of atrial fibrillation and its association with diabetes .............................................................................................................. 4096 8.1.2. Screening and managing atrial fibrillation in patients with diabetes .............................................................................................................. 4096 8.1.3. Preventing stroke in patients with atrial fibrillation and diabetes .............................................................................................................. 4098 8.2. Ventricular arrhythmias and risk of sudden cardiac death and diabetes .................................................................................................................. 4098 9. Chronic kidney disease and diabetes ......................................................... 4099 9.1. Chronic kidney disease definitions, staging, and screening ...... 4099 9.2. Management of cardiovascular disease risk and kidney failure in patients with chronic kidney disease and diabetes ......................... 4100 9.3. Blood pressure and glycaemic control in patients with diabetes and chronic kidney disease .......................................................... 4103 9.4. Roles for antithrombotic therapy and invasive strategies in managing atherosclerotic cardiovascular disease in patients with diabetes and chronic kidney disease .......................................................... 4103 ESC Guidelines 4045 Downloaded from academic.oup.com/eurheartj/article/44/39/4043/7238227 by guest on 07 October 2026