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For patients with diabetes and atherosclerotic cardiovascular disease, if LDL cholesterol is ≥70 mg/dL on maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor) after evaluating the potential for further atherosclerotic cardiovascular disease risk reduction, drug-specific adverse effects, and patient preferences. Ezetimibe may be preferred due to lower cost. A

Statin therapy is contraindicated in pregnancy. B

Patients with type 2 diabetes have an increased prevalence of lipid abnormalities, contributing to their high risk of ASCVD. Multiple clinical trials have demonstrated the beneficial effects of statin therapy on ASCVD outcomes in subjects with and without CHD ( Flexus by Spring Step Wildflower Slipper Womens aI91T0
, RiekerAntistress Mirjam 90 Mary Jane Womens g7bDA
). Subgroup analyses of patients with diabetes in larger trials ( 54 Skechers BOBS Sport Squad Sizzle Sneaker Womens tydByr
) and trials in patients with diabetes ( PUMA Ignite XT Netfit 69ufF
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) showed significant primary and secondary prevention of ASCVD events and CHD death in patients with diabetes. Meta-analyses, including data from over 18,000 patients with diabetes from 14 randomized trials of statin therapy (mean follow-up 4.3 years), demonstrate a 9% proportional reduction in all-cause mortality and 13% reduction in vascular mortality for each mmol/L (39 mg/dL) reduction in LDL cholesterol ( HunterOriginal Short Refined Back Strap Rain Boots wxjvX
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Accordingly, statins are the drugs of choice for LDL cholesterol lowering and cardioprotection. Table 9.2 shows recommended lipid-lowering strategies, and Pleaser Appeal 20G PointedToe Pump Womens 2AZ3rRmT
shows the two statin dosing intensities that are recommended for use in clinical practice: high-intensity statin therapy will achieve approximately a 50% reduction in LDL cholesterol, and moderate-intensity statin regimens achieve 30–50% reductions in LDL cholesterol. Low-dose statin therapy is generally not recommended in patients with diabetes but is sometimes the only dose of statin that a patient can tolerate. For patients who do not tolerate the intended intensity of statin, the maximally tolerated statin dose should be used.

Table 9.2 Table 9.3
View this table:
Table 9.2

Recommendations for statin and combination treatment in adults with diabetes

As in those without diabetes, absolute reductions in ASCVD outcomes (CHD death and nonfatal MI) are greatest in people with high baseline ASCVD risk (known ASCVD and/or very high LDL cholesterol levels), but the overall benefits of statin therapy in people with diabetes at moderate or even low risk for ASCVD are convincing ( 62 , Wild Diva Lounge Clover Ankle Strap Sandal JJAKMuh
). The relative benefit of lipid-lowering therapy has been uniform across most subgroups tested ( 53 , 61 ), including subgroups that varied with respect to age and other risk factors.

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What Is a Drug Intervention?

A successful intervention is not a confrontation but an opportunity for an addicted individual to accept help in taking the first step toward recovery.

A drug intervention is a structured, solution-oriented process undertaken to persuade someone who has a problem with drug or alcohol abuse to Joules Evedon Tall Rain Boot Womens nON4oT
in overcoming the addiction. Family, friends, and others involved in the person's life use the intervention to demonstrate the extent of the effects of substance abuse or alcoholism and related behaviors.

structured, solution-oriented process

A successful intervention is not a confrontation but an opportunity for an addicted individual to accept help in taking the first step toward recovery. Often, an interventionist is invited to serve as a guide and educator before, during, and after the intervention.

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Some people struggling with substance abuse and addiction can and do recognize the extent of the problems stemming from drug abuse and seek treatment without the need for an intervention. Many, however, are reluctant or unable to realize that drugs are responsible for the problems in their relationships, health, or work and often ignore the safety issues related to drinking and driving and other high-risk behaviors.

reluctant or unable

It is common for addicts to deny that drugs are the source of the difficulties they face. They may instead blame other people or circumstances in their lives. When that happens, an intervention can break through the denial and help these individuals clearly see the Pikolinos Puerto Vallarta Closed Toe Sandal 6550575 Womens IomHw
on the people who matter most to them.

break through the denial

The following video from Howcast discusses the factors that can affect the success of an intervention.

A long-held belief is that an addict must reach rock bottom before they will be ready to seek help. This view has been largely debunked by the addiction treatment community. The Indiana Prevention and Resource Center recommends that family and friends Hoka One One Evo Jawz Trail Running Shoe Womens uts6T7
, helping their addicted loved one before sustained damage occurs due to the addiction.

Mission Statement

To ensure you get the best care possible with excellent results from your chiropractor in Raleigh, NC, Dr. Orlasky focuses on finding and treating the underlying cause of your health problem, not just the symptoms.

Our Office

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