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ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD
The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD).

, Lars Rydén, Peter J. Grant, Stefan D. Anker, Christian Berne, Francesco Cosentino, Nicolas Danchin, Christi Deaton, Javier Escaned, Hans-Peter Hammes, Heikki Huikuri, Michel Marre, Nikolaus Marx, Linda Mellbin, Jan Ostergren, Carlo Patrono, Petar Seferovic, Miguel Sousa Uva, Marja-Riita Taskinen, Michal Tendera, Jaakko Tuomilehto, Paul Valensi, Jose Luis Zamorano, , Jose Luis Zamorano, Stephan Achenbach, Helmut Baumgartner, Jeroen J. Bax, Héctor Bueno, Veronica Dean, Christi Deaton, Çetin Erol, Robert Fagard, Roberto Ferrari, David Hasdai, Arno W. Hoes, Paulus Kirchhof, Juhani Knuuti, Philippe Kolh, Patrizio Lancellotti, Ales Linhart, Petros Nihoyannopoulos, Massimo F. Piepoli, Piotr Ponikowski, Per Anton Sirnes, Juan Luis Tamargo, Michal Tendera, Adam Torbicki, William Wijns, Stephan Windecker, , Guy De Backer, Per Anton Sirnes, Eduardo Alegria Ezquerra, Angelo Avogaro, Lina Badimon, Elena Baranova, Helmut Baumgartner, John Betteridge, Antonio Ceriello, Robert Fagard, Christian Funck-Brentano, Dietrich C. Gulba, David Hasdai, Arno W. Hoes, John K. Kjekshus, Juhani Knuuti, Philippe Kolh, Eli Lev, Christian Mueller, Ludwig Neyses, Peter M. Nilsson, Joep Perk, Piotr Ponikowski, Željko Reiner, Naveed Sattar, Volker Schächinger, André Scheen, Henrik Schirmer, Anna Strömberg, Svetlana Sudzhaeva, Juan Luis Tamargo, Margus Viigimaa, Charalambos Vlachopoulos, Robert G. Xuereb
DOI: http://dx.doi.org/10.1093/eurheartj/eht108 First published online: 31 August 2013
  • Guidelines
  • Diabetes mellitus
  • Cardiovascular disease
  • Impaired glucose tolerance
  • Patient management
  • Prevention
  • Epidemiology
  • Prognosis
  • Diagnostics
  • Risk factors
  • Pharmacological treatment
  • Coronary Interventions

Abbreviations and acronyms

2hPG
2-hour post-load plasma glucose
ABI
ankle–brachial index
ACCOMPLISH
Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
Action to Control Cardiovascular Risk in Diabetes
ACE-I
angiotensin converting enzyme inhibitor
ACS
acute coronary syndrome
ACTIVE
Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events
ACTIVE A
Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events Aspirin
ACTIVE W
Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events Warfarin
ADA
American Diabetes Association
ADDITION
Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care
ADP
adenosine diphosphate
ADVANCE
Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation
AF
atrial fibrillation
AGEs
advanced glycation end-products
AIM-HIGH
Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes
ALTITUDE
Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints
Apo
apolipoprotein
ARB
angiotensin receptor blocker
ARIC
Atherosclerosis Risk In Communities
ARISTOTLE
Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation
ASCOT
Anglo-Scandinavian Cardiac Outcomes Trial
ATLAS
Assessment of Treatment with Lisinopril And Survival
AVERROES
Apixaban VERsus acetylsalicylic acid to pRevent strOkES
AWESOME
Angina With Extremely Serious Operative Mortality Evaluation
BARI 2D
Bypass Angioplasty Revascularization Investigation 2 Diabetes
BEST
BEta blocker STroke trial
BMS
bare-metal stent
BP
blood pressure
CABG
coronary artery bypass graft surgery
CAC
coronary artery calcium
CAD
coronary artery disease
CAN
cardiac autonomic neuropathy
CAPRIE
Clopidogrel vs. Aspirin in Patients at Risk of Ischaemic Events
CARDia
Coronary Artery Revascularization in Diabetes
CARDS
Collaborative Atorvastatin Diabetes Study
CETP
cholesterylester transfer protein
CHA2DS2-VASc
cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)
CHADS2
cardiac failure, hypertension, age, diabetes, stroke (doubled)
CHARISMA
Clopidogrel for High Atherothrombotic Risk and Ischaemic Stabilization, Management and Avoidance
CHARM
Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity
CI
confidence interval
CIBIS
Cardiac Insufficiency Bisoprolol Study
CLI
critical limb ischaemia
COMET
Carvedilol Or Metoprolol European Trial
COPERNICUS
Carvedilol Prospective Randomized Cumulative Survival
COX-1 and 2
cyclo-oxygenase 1 and 2
CTT
Cholesterol Treatment Trialists
CVD
cardiovascular disease
DCCT
Diabetes Control and Complications Trial
DECODE
Diabetes Epidemiology: COllaborative analysis of Diagnostic criteria in Europe
DES
drug-eluting stent
DETECT-2
The Evaluation of Screening and Early Detection Strategies for T2DM and IGT
DIABHYCAR
Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events and Ramipril
DIAMOND
Danish Investigations and Arrhythmia ON Dofetilide
DIG
Digitalis Investigation Group
DIGAMI
Diabetes and Insulin–Glucose Infusion in Acute Myocardial Infarction
DIRECT
DIabetic REtinopathy Candesartan Trials
DM
diabetes mellitus
DPP-4
dipeptidylpeptidase-4
ECG
electrocardiogram
EDIC
Epidemiology of Diabetes Interventions and Complications
eNOS
endothelial nitric oxide synthase
EPC
endothelial progenitor cells
ERFC
Emerging Risk Factor Collaboration
EUROASPIRE
European Action on Secondary Prevention through Intervention to Reduce Events
EUROPA
EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease
FDA
Food and Drug Administration
FFA
free fatty acid
FIELD
Fenofibrate Intervention and Event Lowering in Diabetes
FINDRISC
FINnish Diabetes RIsk SCore
FPG
fasting plasma glucose
FREEDOM
Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease
GFR
glomerular filtration rate
GIK
glucose-insulin-potassium
GLP-1
glucagon-like peptide-1
GLUT-4
glucose transporter 4
HAS-BLED
Hypertension, Abnormal renal/liver function (1 point each), Stroke, Bleeding history or predisposition, Labile INR, Elderly (>65), Drugs/alcohol concomitantly (1 point each)
HbA1c
glycated haemoglobin A1C
HDL
high-density lipoprotein
HDL-C
high-density lipoprotein cholesterol
HI-5
Hyperglycaemia: Intensive Insulin Infusion in Infarction
HOMA-IR
Homeostasis Model Assessment of Insulin Resistance
HOPE
Heart Outcomes Prevention Evaluation
HOT
Hypertension Optimal Treatment
HPS
Heart Protection Study
HPS-2-THRIVE
Heart Protection Study 2 Treatment of HDL to Reduce the Incidence of Vascular Events
HR
hazard ratio
HSP
hexosamine pathway
IFG
impaired fasting glucose
IGT
impaired glucose tolerance
IMMEDIATE
Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care
IMPROVE-IT
IMProved Reduction of Outcomes: Vytorin Efficacy International Trial
INR
international normalized ratio
IR
insulin resistance
IRS-1
insulin receptor substrate-1
ISAR-REACT
Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment
ITA
internal thoracic artery
LDL
low-density lipoprotein
LDL-C
low-density lipoprotein cholesterol
LEAD
lower extremity artery disease
Lp a
lipoprotein a
LV
left ventricular
LVEF
left ventricular ejection fraction
MACCE
major adverse cardiac and cerebrovascular events
MAIN COMPARE
Revascularization for unprotected left main coronary artery stenosis: comparison of percutaneous
MERIT-HF
Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure
MetS
metabolic syndrome
MI
myocardial infarction
MRA
mineralocorticoid receptor antagonists
N-ER
niacin
NAPDH
nicotinamide adenine dinucleotide phosphate hydrogen
NDR
National Diabetes Register
NHANES
National Health and Nutrition Examination Survey
NICE
National Institute for Health and Clinical Excellence (UK)
NNT
number needed to treat
NO
nitric oxide
NOAC
new oral anticoagulants
NYHA
New York Heart Association
OAT
Occluded Artery Trial
OGTT
oral glucose tolerance test
OMT
optimal medical treatment
ONTARGET
ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial
OR
odds ratio
ORIGIN
Outcome Reduction with an Initial Glargine Intervention trial
PAD
peripheral artery disease
PAI-1
plasminogen activator inhibitor-1
PCI
percutaneous coronary intervention
PG
plasma glucose
PI3K
phosphatidylinositol 3-kinases
PKC
protein kinase C
PLATO
PLATelet inhibition and patient Outcomes trial
PPARα
peroxisome proliferator-activated receptor alpha
PPARγ
peroxisome proliferator-activated receptor gamma
PREDIMED
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
PROActive
PROspective pioglitAzone Clinical Trial In macroVascular Events
PROCAM
Prospective Cardiovascular Münster
RAAS
renin-angiotensin-aldosterone system
RAGE
receptor for advanced glycation end products
RCT
randomized controlled trial
RE-LY
Randomized Evaluation of the Long-term anticoagulant therapy with dabigatran etexilate
REGICOR
Myocardial Infarction Population Registry of Girona
RESOLVE
Safety and Efficacy of Ranibizumab in Diabetic Macular Edema Study
RESTORE
Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema
RIDE
Ranibizumab Injection in Subjects With Clinically Significant Macular Edema (ME) With Center Involvement Secondary to Diabetes Mellitus
RISE
Ranibizumab Injection in Subjects With Clinically Significant Macular Edema (ME) With Center Involvement Secondary to Diabetes Mellitus
ROCKET
Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition, compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation
ROS
reactive oxygen species
RRR
relative risk reduction
SCORE®
The European Systematic Coronary Risk Evaluation
SGLT2
sodium–glucose co-transporter-2
SHARP
Study of Heart and Renal Protection
SMI
silent myocardial ischaemia
SR-B
scavenger receptor B
SOLVD
Studies Of Left Ventricular Dysfunction
STEMI
ST-elFevation myocardial infarction
SYNTAX
SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery
T1DM
type 1 diabetes mellitus
T2DM
type 2 diabetes mellitus
TACTICS-TIMI 18
Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction
TG
triglyceride
TIA
transient ischaemic attack
tPA
tissue plasminogen activator
TRL
triglyceride-rich lipoprotein
UKPDS
United Kingdom Prospective Diabetes Study
VADT
Veterans Administration Diabetes Trial
VEGF
vascular endothelial growth factor
VKA
vitamin K antagonist
VLDL
very low-density lipoprotein
WHO
World Health Organization

1. Preamble

This is the second iteration of the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) joining forces to write guidelines on the management of diabetes mellitus (DM), pre-diabetes, and cardiovascular disease (CVD), designed to assist clinicians and other …