{"id":43742,"date":"2023-09-22T14:40:37","date_gmt":"2023-09-22T07:40:37","guid":{"rendered":"https:\/\/hmm88i.com\/drug\/?p=43742"},"modified":"2024-05-06T11:06:06","modified_gmt":"2024-05-06T04:06:06","slug":"esc-2023-huong-dan-dieu-tri-benh-ly-tim-mach-tren-benh-nhan-co-dai-thao-duong","status":"publish","type":"post","link":"https:\/\/hmm88i.com\/drug\/esc-2023-huong-dan-dieu-tri-benh-ly-tim-mach-tren-benh-nhan-co-dai-thao-duong\/","title":{"rendered":"ESC 2023 H\u01af\u1edaNG D\u1eaaN \u0110I\u1ec0U TR\u1eca B\u1ec6NH L\u00dd TIM M\u1ea0CH TR\u00caN B\u1ec6NH NH\u00c2N C\u00d3 \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG"},"content":{"rendered":"

ESC 2023 H\u01af\u1edaNG D\u1eaaN \u0110I\u1ec0U TR\u1eca B\u1ec6NH L\u00dd TIM M\u1ea0CH<\/strong>
\nTR\u00caN B\u1ec6NH NH\u00c2N C\u00d3 \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG<\/strong><\/p>\n

Table 1 Classes of recommendations<\/strong><\/p>\n\n\n\n\n\n\n\n\n
<\/td>\nDefinition<\/td>\nWording to use<\/td>\n<\/tr>\n
Class I<\/td>\nB\u1eb1ng ch\u1ee9ng v\u00e0\/ho\u1eb7c s\u1ef1 \u0111\u1ed3ng thu\u1eadn
\nr\u1eb1ng vi\u1ec7c \u0111i\u1ec1u tr\u1ecb hay th\u1ee7 thu\u1eadt s\u1ebd c\u00f3 l\u1ee3i
\n\u00edch<\/td>\n		Is recommended or is indicated<\/td>\n<\/tr>\n
Class II<\/td>\nC\u00f3 s\u1ef1 m\u00e2u thu\u1ea9n gi\u1eefa c\u00e1c b\u1eb1ng ch\u1ee9ng ho\u1eb7c s\u1ef1 kh\u00f4ng nh\u1ea5t qu\u00e1n \u0111\u1ed3ng thu\u1eadn<\/td>\n<\/tr>\n
Class IIa<\/td>\nC\u00e1n c\u00e2n b\u1eb1ng ch\u1ee9ng\/ \u00fd ki\u1ebfn chuy\u00ean
\ngia nghi\u00eang v\u1ec1 c\u00f3 l\u1ee3i<\/td>\n		Should be considered<\/td>\n<\/tr>\n
Class IIb<\/td>\nC\u00e1n c\u00e2n b\u1eb1ng ch\u1ee9ng\/ \u00fd ki\u1ebfn chuy\u00ean
\ngia nghi\u00eang v\u1ec1 \u00cdT c\u00f3 l\u1ee3i<\/td>\n		May be considered<\/td>\n<\/tr>\n
Class III<\/td>\nB\u1eb1ng ch\u1ee9ng v\u00e0\/ho\u1eb7c s\u1ef1 \u0111\u1ed3ng thu\u1eadn
\nr\u1eb1ng vi\u1ec7c \u0111i\u1ec1u tr\u1ecb hay th\u1ee7 thu\u1eadt s\u1ebd
\nKH\u00d4NG c\u00f3 l\u1ee3i \u00edch, ho\u1eb7c g\u00e2y h\u1ea1i.<\/td>\n		Is not recommended<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 2 Levels of evidence<\/strong><\/p>\n\n\n\n\n\n
Level of
\nevidence A<\/td>\n		D\u1eef li\u1ec7u b\u1eaft ngu\u1ed3n t\u1eeb nhi\u1ec1u nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean ho\u1eb7c c\u00e1c nghi\u00ean c\u1ee9u t\u1ed5ng h\u1ee3p.<\/td>\n<\/tr>\n
Level of
\nevidence B<\/td>\n		D\u1eef li\u1ec7u b\u1eaft ngu\u1ed3n t\u1eeb M\u1ed8T nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean \u0111\u01a1n l\u1ebb ho\u1eb7c c\u00e1c nghi\u00ean c\u1ee9u l\u1edbn nh\u01b0ng kh\u00f4ng c\u00f3 t\u00ednh ng\u1eabu nhi\u00ean.<\/td>\n<\/tr>\n
Level of
\nevidence C<\/td>\n		D\u1eef li\u1ec7u b\u1eaft ngu\u1ed3n t\u1eeb s\u1ef1 \u0111\u1ed3ng thu\u1eadn c\u1ee7a c\u00e1c chuy\u00ean gian v\u00e0\/ho\u1eb7c c\u00e1c nghi\u00ean c\u1ee9u nh\u1ecf, nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

1. Gi\u1edbi Thi\u1ec7u<\/h2>\n

B\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng s\u1ebd \u0111i k\u00e8m vi\u1ec7c tnawg nguy c\u01a1 ph\u00e1t tri\u1ec3n c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch v\u1edbi h\u00ecnh di\u1ec7n b\u1ec7nh c\u1ea3nh c\u1ee7a b\u1ec7nh l\u00fd m\u1ea1ch v\u00e0nh, suy tim, rung nh\u0129, v\u00e0 \u0111\u1ed9t qu\u1ecb c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean. Th\u00eam n\u1eefa, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n, m\u00e0 c\u00f3 th\u1ec3 quay l\u1ea1i \u1ea3nh h\u01b0\u1edfng v\u00e0 g\u00e2y ra b\u1ec7nh tim m\u1ea1ch. S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 c\u00e1c b\u1ec7nh tim-th\u1eadn \u0111\u1ed3ng m\u1eafc n\u00e0y kh\u00f4ng ch\u1ec9 l\u00e0m t\u0103ng nguy c\u01a1 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch m\u00e0 c\u00f2n c\u00f3 th\u1ec3 g\u00e2y t\u0103ng nguy c\u01a1 t\u1eed vong do t\u1ea5t c\u1ea3 c\u00e1 nguy\u00ean nh\u00e2n kh\u00e1c. H\u01b0\u1edbng d\u1eabn d\u01b0\u1edbi \u0111\u00e2y s\u1eafp \u0111\u01b0\u1ee3c n\u00eau ra \u0111\u01b0\u1ee3c d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u c\u1eadp nh\u1eadt m\u1edbi nh\u1ea5t \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m cu\u1ed1i th\u00e1ng 1 n\u0103m 2023. Tr\u1ea3i qua 1 th\u1eadp k\u1ef7, k\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng l\u1edbn
\ntr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng k\u00e8m nguy c\u01a1 cao tim m\u1ea1ch v\u1edbi c\u00e1c thu\u1ed1c SGLT-2 v\u00e0 GLP-1 c\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c MRA nh\u01b0 finerenone \u0111\u00e3 m\u1edf r\u1ed9ng c\u01a1 h\u1ed9i v\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb cho nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n

C\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n t\u1ea1i \u2013 tr\u00e1i v\u1edbi h\u01b0\u1edbng d\u1eabn ra m\u1eaft n\u0103m 2019 ESC, tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u0110, ti\u1ec1n \u0110T\u0110 v\u00e0 b\u1ec7nh l\u00fd tim m\u1ea1ch, ch\u1ec9 t\u1eadp trung v\u00e0o b\u1ec7nh l\u00fd tim m\u1ea1ch v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, thi\u1ebfu b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng.
\n\u0110i\u1ec3m m\u1ea1nh c\u1ee7a h\u01b0\u1edbng d\u1eabn l\u1ea7n n\u00e0y, ESC b\u1ed5 sung th\u00eam chi\u1ebfn l\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nguy c\u01a1 tim m\u1ea1ch, c\u0169ng nh\u01b0 c\u00e1ch t\u1ea7 so\u00e1t, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110. V\u1edbi c\u00e1c m\u00f4 th\u1ee9c v\u1ea5n \u0111\u1ec1n kh\u00e1c ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o c\u00e1c b\u1ea1n tham kh\u1ea3o th\u00eam h\u1ee9ng d\u1eabn c\u1ee7a ADA v\u00e0 h\u1ed9i EASD.<\/p>\n

H\u01b0\u1edbng d\u1eabn n\u00e0y gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch m\u00e0 c\u00f3 k\u00e8m b\u1ec7nh \u0110T\u0110, c\u0169ng nh\u01b0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tim m\u1ea1ch do x\u01a1 v\u1eefa tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110. \u0110\u1ec3 c\u00e1c nh\u00e2n ho\u00e1 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, h\u01b0\u1edbng d\u1eabn c\u0169ng c\u00f4ng b\u1ed1 thang \u0111i\u1ec3m nguy c\u01a1 tim m\u1ea1ch 10 n\u0103m cho ri\u00eang c\u00e1c c\u00e1 nh\u00e2n c\u00f3 \u0110T\u0110 k\u00e8m theo (SCORE2-Diabetes) . Thang \u0111i\u1ec3m n\u00e0y nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 gi\u00fap quy\u1ebft \u0111\u1ecbnh ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n v\u00e0o c\u00e1c m\u1ee9c \u0111\u1ed9: th\u1ea5p \u2013 trung b\u00ecnh \u2013 cao \u2013 r\u1ea5t cao, nh\u01b0ng s\u1ebd kh\u00f4ng \u00e1p d\u1ee5ng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch do x\u01a1 v\u1eefa ho\u1eb7c \u0111\u00e3 c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u1ecbch n\u1eb7ng.<\/p>\n

D\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u l\u1edbn, h\u01b0\u1edbng d\u1eabn l\u1ea7n n\u00e0y c\u0169ng \u0111\u01b0a ra c\u00e1ch \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110 k\u00e8m theo b\u1ec7nh tim-th\u1eadn \u0111\u1ed3ng m\u1eafc. V\u00ed d\u1ee5 nh\u01b0 tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u0110 k\u00e8m theo c\u00f3 ASCVD (b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa) \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c nh\u01b0 GLP-1 RAs and\/or SGLT2 inhibitors \u0111\u1ec1u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch, v\u00e0 \u0111\u1ed9c l\u1eadp kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u1edbi vi\u1ec7c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft c\u0169ng nh\u01b0 \u0111\u1ed9c l\u1eadp v\u1edbi c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb kh\u00e1c nh\u01b0: kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p hay thu\u1ed1c h\u1ea1 lipid m\u00e1u…Cu\u1ed1i c\u00f9ng, tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110 k\u00e8m b\u1ec7nh th\u1eadn m\u1ea1n, h\u01b0\u1edbng d\u1eabn khuy\u1ebfn c\u00e1o h\u00e3y \u0111i\u1ec1u tri v\u1edbi SGLT2 inhibitor v\u00e0\/ho\u1eb7c finerenone, do c\u00e1c thu\u1ed1c n\u00e0y l\u00e0m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch v\u00e0 suy th\u1eadn.<\/p>\n

\"ESC<\/a><\/p>\n

2. C\u00e1c \u0111i\u1ec3m m\u1edbi c\u1ee7a guidelines 2023<\/h2>\n

Table 3 New recommendations<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
\u0110\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\n<\/tr>\n
Tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u0110-2 kh\u00f4ng c\u00f3 ASCVD ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng
\nt\u1ea1ng n\u1eb7ng, khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thang \u0111i\u1ec3m SCORE2-
\nDiabetes \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch 10 n\u0103m<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
Weight reduction in patients with diabetes\u2014Section 5.1.1<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o b\u1ec7nh nh\u00e2n t\u0103ng c\u00e2n, b\u00e9o ph\u00ec t\u0103ng c\u01b0\u1eddng gi\u1ea3m
\nc\u00e2n v\u00e0 t\u0103ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c \u0111\u1ec3 c\u1ea3i thi\u1ec7n chuy\u1ec3n ho\u00e1 v\u00e0
\nnguy c\u01a1 tim m\u1ea1ch chung.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
C\u00e1c thu\u1ed1c h\u1ea1 th\u1ea5p \u0111\u01b0\u1eddng huy\u1ebft k\u00e8m hi\u1ec7u qu\u1ea3 gi\u1ea3m c\u00e2n
\n(nh\u01b0 GLP-1 RAs) n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 b\u00e9o ph\u00ec ho\u1eb7c th\u1eeba c\u00e2n.<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n
Ph\u1eabu thu\u1eadt gi\u1ea3m b\u00e9o n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t tr\u00ean c\u00e1c b\u1ec7nh
\nnh\u00e2n nguy c\u01a1 r\u1ea5t cao k\u00e8m BMI \u2265 35 kg\/m2 (\u2265Class II) khi
\nc\u00e1c thu\u1ed1c v\u00e0 thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng nh\u1eb1m gi\u1ea3m c\u00e2n kh\u00f4ng th\u1ec3
\nduy tr\u00ec k\u1ebft qu\u1ea3 mong mu\u1ed1n.<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n
Smoking cessation in patients with diabetes\u2014Section 5.1.4<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p Nicotine thay th\u1ebf, varenicline v\u00e0 bupropion
\nc\u0169ng nh\u01b0 c\u00e1c bi\u1ec7n ph\u00e1p t\u01b0 v\u1ea5n, n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 h\u1ed7
\ntr\u1ee3 b\u1ecf thu\u1ed1c l\u00e1 th\u00e0nh c\u00f4ng.<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n
Glycaemic targets\u2014Section 5.2<\/td>\n<\/tr>\n
Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft ch\u1eb7t ch\u1ebd, nh\u1eb1m gi\u1ea3m b\u1ec7nh tim
\nm\u1ea1ch v\u1ec1 l\u00e2u v\u1ec1 d\u00e0i, \u01b0u ti\u00ean s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c
\nch\u1ee9ng minh c\u00f3 l\u1ee3i \u00edch.<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

<\/h2>\n\n\n\n\n\n\n\n\n
Atherosclerotic cardiovascular disease risk reduction by glucose-lowering medications in diabetes\u2014Section 5.3<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o \u01b0u ti\u00ean s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c h\u1ea1 \u0110H c\u00f3 ch\u1ee9ng minh l\u1ee3i \u00edch tr\u00ean tim m\u1ea1ch<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
N\u1ebfu ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft c\u1ea7n th\u00eam thu\u1ed1c, Metformin n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u0110-2 v\u00e0 ASCVD<\/td>\nIIa<\/td>\nC<\/td>\n<\/tr>\n
N\u1ebfu ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft c\u1ea7n th\u00eam thu\u1ed1c, Pioglitazone n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u0110-2 v\u00e0 ASCVD nh\u01b0ng kh\u00f4ng c\u00f3 suy tim k\u00e8m theo<\/td>\nIIb<\/td>\nB<\/td>\n<\/tr>\n
Blood pressure and diabetes\u2014Section 5.4<\/td>\n<\/tr>\n
\u0110o huy\u1ebft \u00e1p th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u0110 \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb THA<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Lipids and diabetes\u2014Section 5.5<\/td>\n<\/tr>\n
Thu\u1ed1c \u1ee9c ch\u1ebf PCSK9 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 tim m\u1ea1ch r\u1ea5t cao, v\u1edbi LDL cao tr\u01b0\u1eddng k\u1ef3 d\u00f9 \u0111\u00e3 t\u1ed1i \u0111a li\u1ec1u Statin dung n\u1ea1p, k\u1ebft h\u1ee3p th\u00eam ezetimibe ho\u1eb7c tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c
\nstatin.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
N\u1ebfu m\u1ed9t ph\u00e1c \u0111\u1ed3 c\u00f3 statin kh\u00f4ng th\u1ec3 dung n\u1ea1p tr\u00ean b\u1ec7nh nh\u00e2n, \u1ee9c ch\u1ebf PCSK9 k\u1ebft h\u1ee3p ezetimibe \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng<\/td>\nIIa<\/td>\nB<\/td>\n<\/tr>\n
N\u1ebfu m\u1ed9t ph\u00e1c \u0111\u1ed3 c\u00f3 statin kh\u00f4ng th\u1ec3 dung n\u1ea1p tr\u00ean b\u1ec7nh nh\u00e2n, ezetimibe \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o xem x\u00e9t d\u00f9ng<\/td>\nIIa<\/td>\nC<\/td>\n<\/tr>\n
Li\u1ec1u cao Icosapent ethyl (2g \u2013 2 l\u1ea7n\/ng\u00e0y) c\u00f3 th\u1ec3 xem x\u00e9t k\u1ebft h\u1ee3p c\u00f9ng statin tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n t\u0103ng Triglyceride.<\/td>\nIIb<\/td>\nB<\/td>\n<\/tr>\n
Antithrombotic therapy in patients with diabetes\u2014Section 5.6<\/td>\n<\/tr>\n
Clopidogrel 75mg u\u1ed1ng sau li\u1ec1u t\u1ea3i (vd 600mg ho\u1eb7c \u00edt nh\u1ea5t 5 ng\u00e0y c\u00f9ng li\u1ec1u duy tr\u00ec) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng chung ASA th\u1eddi gian 6 th\u00e1ng sau \u0111\u1eb7t stent m\u1ea1ch v\u00e0nh tr\u00ean b\u1ec7nh nh\u00e2n CCS, n\u1ebfu nh\u01b0 kh\u00f4ng x\u1ea3y ra c\u00e1c bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft \u0111e do\u1ea1 t\u00ednh m\u1ea1ng \u0111\u1ec3 ph\u1ea3i r\u00fat ng\u1eafn th\u1eddi gian li\u1ec7u tr\u00ecnh.<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u0110 k\u00e8m ACS \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng DAPT m\u00e0 \u0111ang c\u00f3 CABG v\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb OAC l\u00e2u d\u00e0i, khuy\u1ebfn c\u00e1o ti\u1ebfp t\u1ee5c d\u00f9ng P2Y12 s\u1edbm sau ph\u1eabu thu\u1eadt khi cho r\u1eb1ng \u0111\u00e3 an to\u00e0n v\u00e0 ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng l\u00ean \u0111\u1ebfn 12 th\u00e1ng.<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
Vi\u1ec7c th\u00eam li\u1ec1u r\u1ea5t th\u1ea5p thu\u1ed1c Rivaroxaban c\u00f9ng li\u1ec1u th\u1ea5p
\nASA d\u00f9ng l\u00e2u d\u00e0i \u0111\u1ec3 ng\u0103n c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u n\u1eb7ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u0110 v\u00e0 CCS ho\u1eb7c PAD c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1ebfu h\u1ecd kh\u00f4ng c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft cao.<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n ACS ho\u1eb7c CCS k\u00e8m theo \u0110T\u0110 \u0111ang
\n\u0111\u1eb7t stent m\u1ea1ch v\u00e0nh v\u00e0 c\u00f3 ch\u1ec9 \u0111\u1ecbnh 3 thu\u1ed1c kh\u00e1ng \u0111\u00f4ng
\ns\u1eed d\u1ee5ng l\u00e2u d\u00e0i (ASA li\u1ec1u th\u1ea5p, clopidogrel, v\u00e0 m\u1ed9t
\nOAC) n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng l\u00ean \u0111\u1ebfn 1 th\u00e1ng n\u1ebfu
\nnguy c\u01a1 huy\u1ebft kh\u1ed1i cao h\u01a1n nguy c\u01a1 ch\u1ea3y m\u00e1u tr\u00ean
\nt\u1eebng c\u00e1 th\u1ec3 b\u1ec7nh nh\u00e2n<\/td>\n		IIa<\/td>\nC<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n ACS ho\u1eb7c CCS k\u00e8m theo \u0110T\u0110 \u0111ang
\n\u0111\u1eb7t stent m\u1ea1ch v\u00e0nh v\u00e0 c\u00f3 ch\u1ec9 \u0111\u1ecbnh 3 thu\u1ed1c kh\u00e1ng \u0111\u00f4ng
\ns\u1eed d\u1ee5ng l\u00e2u d\u00e0i (ASA li\u1ec1u th\u1ea5p, clopidogrel, v\u00e0 m\u1ed9t
\nOAC) n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng l\u00ean \u0111\u1ebfn 3 th\u00e1ng n\u1ebfu
\nnguy c\u01a1 huy\u1ebft kh\u1ed1i cao h\u01a1n nguy c\u01a1 ch\u1ea3y m\u00e1u tr\u00ean
\nt\u1eebng c\u00e1 th\u1ec3 b\u1ec7nh nh\u00e2n<\/td>\n		IIb<\/td>\nC<\/td>\n<\/tr>\n
Khi Clopidogrel \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ,omeprazole v\u00e0
\nesomeprazole kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 b\u1ea3o v\u1ec7 d\u1ea1
\nd\u00e0y.<\/td>\n		III<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n\n
Management of coronary artery disease in patients with diabetes\u2014Section 6<\/td>\n<\/tr>\n
T\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh v\u1edbi CCS \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\nkhi \u0111au th\u1eaft ng\u1ef1c dai d\u1eb3ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb v\u1edbi
\nc\u00e1c thu\u1ed1c \u0111au th\u1eaft ng\u1ef1c ho\u1eb7c tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n
\nghi nh\u1eadn thi\u1ebfu m\u00e1u di\u1ec7n r\u1ed9ng (10% LV)<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
T\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh ho\u00e0n to\u00e0n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\nv\u1edbi STEMI kh\u00f4ng c\u00f3 s\u1ed1c tim v\u00e0 CAD \u0111a m\u1ea1ch m\u00e1u<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
\u0110\u00e1nh gi\u00e1 \u0111\u01b0\u1eddng huy\u1ebft ban \u0111\u1ea7u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\ntr\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n v\u1edbi ACS<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
T\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh ho\u00e0n to\u00e0n c\u00e2n nh\u1eafc v\u1edbi
\nNSTE-ACS kh\u00f4ng s\u1ed1c tim v\u00e0 CAD \u0111a m\u1ea1ch m\u00e1u<\/td>\n		IIa<\/td>\nC<\/td>\n<\/tr>\n
\u0110i\u1ec1u ch\u1ec9nh \u0110H n\u00ean c\u00e2n nh\u1eafc tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3
\nACS k\u00e8m t\u0103ng \u0110H dai d\u1eb3ng, v\u00e0 tr\u00e1nh h\u1ea1 \u0110H<\/td>\n		IIa<\/td>\nC<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb t\u00e1i th\u00f4ng th\u01b0\u1eddng qui kh\u1ea9n c\u1ee7a c\u00e1c sang
\nth\u01b0\u01a1ng non-culprit tr\u00ean b\u1ec7nh nh\u00e2n NMCT v\u00e0
\nb\u1ec7nh \u0111a m\u1ea1ch m\u00e1u v\u1edbi s\u1ed1c tim kh\u00f4ng \u0111\u01b0\u1ee3c
\nkhuy\u1ebfn c\u00e1o<\/td>\n		III<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n
Heart failure and diabetes\u2014Section 7<\/td>\n<\/tr>\n
Evaluation for heart failure in diabetes<\/td>\n<\/tr>\n
N\u1ebfu nghi ng\u1edd suy tim, x\u00e9t nghi\u1ec7m BNP\/NT- proBNP \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n
T\u00ecm ki\u1ebfm c\u00e1c tri\u1ec7u ch\u1ee9ng\/d\u1ea5u hi\u1ec7u suy tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110<\/td>\nI<\/td>\nC<\/td>\n<\/tr>\n
Diagnostic tests in all patients with suspected heart failure<\/td>\n<\/tr>\n
X quang ng\u1ef1c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\nSi\u00eau \u00e2m tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\n\u0110o \u0111i\u1ec7n tim 12 chuy\u1ec3n \u0111\u1ea1o \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o<\/td>\n		I<\/td>\nC<\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m m\u00e1u th\u01b0\u1eddng qui c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc
\nkhuy\u1ebfn c\u00e1o n\u00ean l\u00e0m, g\u1ed3m c\u00f4ng th\u1ee9c m\u00e1u,
\nure,creatinine v\u00e0 \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ch\u1ee9c n\u0103ng tuy\u1ebfn
\ngi\u00e1p, bilan m\u1ee1, s\u1eaft (ferritin v\u00e0 TSAT)<\/td>\n		I<\/td>\nC<\/td>\n<\/tr>\n
Pharmacological treatment indicated in patients with HFrEF
\n(NYHA class II\u2013IV) and diabetes<\/td>\n<\/tr>\n
SGLT-2 (dapagliflozin, empagliflozin, sotagliflozin)
\n\u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n
\nHFrEF k\u00e8m \u0110T\u0110-2, \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 nh\u1eadp vi\u1ec7n v\u00e0
\nt\u1eed vong tim m\u1ea1ch<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c, s\u1edbm c\u00e1c thu\u1ed1c
\n(SGLT-2, ARNI\/ACEi, ch\u1eb9n beta, v\u00e0 MRA), ch\u1ec9nh
\nnhanh \u0111\u1ebfn li\u1ec1u m\u1ee5c ti\u00eau tr\u01b0\u1edbc khi xu\u1ea5t vi\u1ec7n v\u00e0
\ntheo d\u00f5i th\u01b0\u1eddng xuy\u00ean trong 6 tu\u1ea7n \u0111\u01b0\u1ee3c
\nkhuy\u1ebfn c\u00e1o \u0111\u1ec3 gi\u1ea3m t\u00e1i nh\u1eadp vi\u1ec7n ho\u1eb7c t\u1eed vong.<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

<\/h2>\n\n\n\n\n\n\n\n
Other treatments indicated in selected patients with HFrEF (NYHA class II\u2013IV) and diabetes<\/td>\n<\/tr>\n
Hydralazine v\u00e0 isosorbide dinitrate n\u00ean xem x\u00e9t
\ntr\u00ean b\u1ec7nh nh\u00e2n dan \u0111en c\u00f3 \u0110T\u0110 k\u00e8m LVEF\u226435%
\nho\u1eb7c v\u1edbi LVEF<45% k\u00e8m th\u1ea5t tr\u00e1i gi\u00e3n tr\u00ean NYHA
\nIII-IV d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb v\u1edbi ACEi(ho\u1eb7c ARNI), ch\u1eb9n
\nbeta, v\u00e0 1 thu\u1ed1c MRA, \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 suy tim
\nnh\u1eadp vi\u1ec7n v\u00e0 t\u1eed vong<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n
Digoxin c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3
\nnh\u1ecbp xoang v\u1edbi HFrEF c\u00f3 tri\u1ec7u ch\u1ee9ng, d\u00f9 \u0111\u00e3 \u0111i\u1ec1u
\ntr\u1ecb v\u1edbi sacubitril\/valsartan ho\u1eb7c 1 ACEi, 1 ch\u1eb9n
\nbeta, v\u00e0 1 MRA, \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 nh\u1eadp vi\u1ec7n<\/td>\n		IIb<\/td>\nB<\/td>\n<\/tr>\n
Heart failure treatments in patients with diabetes and LVEF >40%<\/td>\n<\/tr>\n
Empagliflozin ho\u1eb7c Dapagliflozin \u0111\u01b0\u1ee3c khuy\u1ebfn
\nc\u00e1o tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m LVEF>40%
\n(HFmrEF v\u00e0 HFpEF) \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 suy tim nh\u1eadp
\nvi\u1ec7n ho\u1eb7c t\u1eed vong do tim m\u1ea1ch.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n\n\n
Chronic kidney disease and diabetes\u2014Section 9<\/td>\n<\/tr>\n
H\u1ea1 t\u00edch c\u1ef1c LDL-C b\u1eb1ng statin ho\u1eb7c k\u1ebft h\u1ee3p
\nstatin\/ezetimibe \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
SGLT-2 (dapagliflozin, empagliflozin, canagliflozin) \u0111\u01b0\u1ee3c
\nkhuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m BTM v\u1edbi
\neGFR \u226520 mL\/min\/1.73 m2 \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch
\nv\u00e0 suy th\u1eadn<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Finerenone \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o b\u1ed5 sung th\u00eam v\u00e0o v\u1edbi
\nACEi\/ARB tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m eGFR \u226560
\nmL\/min\/1.73 m2 v\u1edbi m\u1ed9t UACR\u226530 mg\/mmol
\n(\u2265300mg\/g), ho\u1eb7c eGFR 25-60 mL\/min\/1.73 m2 v\u1edbi m\u1ed9t
\nUACR \u22653mg\/mmol (\u226530mg\/g) \u0111\u1ec3 gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim
\nm\u1ea1ch v\u00e0 suy th\u1eadn.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Li\u1ec1u th\u1ea5p ASA (75-100mg\/ng\u00e0y) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean
\nc\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi BTM k\u00e8m ASCVD<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u00edch c\u1ef1c so v\u1edbi \u0111i\u1ec1u tr\u1ecb x\u00e2m l\u1ea5n ban
\n\u0111\u1ea7u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean b\u1ec7nh nh\u00e2n v\u1edbi BTM, \u0110T\u0110, v\u00e0
\nb\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, cho ra k\u1ebft qu\u1ea3 nh\u01b0 nhau<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
C\u00e1c nh\u00e0 th\u1eadn h\u1ecdc khuy\u00ean c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb t\u0103ng
\nphosphate m\u00e1u, b\u1eb1ng ch\u1ee9ng kh\u00e1c c\u1ee7a r\u1ed1i lo\u1ea1n chuy\u1ec3n
\nho\u00e1 x\u01b0\u01a1ng tr\u00ean BTM, v\u00e0 thi\u1ebfu m\u00e1u do th\u1eadn.<\/td>\n		IIb<\/td>\nC<\/td>\n<\/tr>\n
S\u1eed d\u1ee5ng k\u1ebft h\u1ee3p thu\u1ed1c ARB v\u1edbi m\u1ed9t ACEi kh\u00f4ng \u0111\u01b0\u1ee3c
\nkhuy\u1ebfn c\u00e1o<\/td>\n		III<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

ACE-I, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; AF, atrial
\nfibrillation; ARB, angiotensin-II receptor blocker; ARNI, angiotensin receptor\u2013neprilysin
\ninhibitor; ASA, acetylsalicylic acid; ASCVD, atherosclerotic cardiovascular disease; b.i.d.,
\ntwice a day; BMI, body mass index; BNP, B-type natriuretic peptide; BP, blood pressure;
\nCABG, coronary artery bypass graft; CAD, coronary artery disease; CCS, chronic
\ncoronary syndrome; CKD-MBD, chronic kidney disease\u2013mineral bone disorder; CV,
\ncardiovascular; CVD, cardiovascular disease; DAPT, dual antiplatelet therapy; ECG,
\nelectrocardiogram; eGFR, estimated glomerular filtration rate; GLP-1 RA, glucagon-like
\npeptide-1 receptor agonist; HF, heart failure; HFmrEF, heart failure with mildly reduced
\nejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart
\nfailure with reduced ejection fraction; LDL-C, low-density lipoprotein-cholesterol; LV,
\nleft ventricular\/ventricle; LVEF, left ventricular ejection fraction; MI, myocardial infarction;
\nMRA, mineralocorticoid receptor antagonist; NSTE-ACS, non-ST-elevation acute
\ncoronary syndrome; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA,
\nNew York Heart Association; OAC, oral anticoagulant; o.d., once daily; PAD, peripheral
\narterial disease; PCSK9, proprotein convertase subtilisin\/kexin type 9; T1DM, type 1
\ndiabetes mellitus; T2DM, type 2 diabetes mellitus; TOD, target-organ damage; TSAT,
\ntransferrin saturation; SCORE2-Diabetes, type 2 diabetes-specific 10-year CVD risk
\nscore; SGLT2, sodium\u2013glucose co-transporter-2; STEMI, ST-elevation myocardial
\ninfarction; UACR, urinary albumin-to-creatinine ratio. a
\nClass of recommendation. b
\nLevel of evidence.<\/p>\n

B\u1ea3ng: \u0110\u00e1nh gi\u00e1 s\u1ef1 thay \u0111\u1ed5i gi\u1eefa guideline 2019 >< 2023<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
2019<\/td>\nClass<\/td>\nLevel<\/td>\n2023<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Change in diet and nutrition in patients with diabetes\u2014Section 5.1.2<\/td>\n<\/tr>\n
A Mediterranean diet, rich in polyunsaturated and monounsaturated fats, should be considered to reduce CV events.<\/td>\nIIa<\/td>\nB<\/td>\nIt is recommended to adopt a Mediterranean or plant-based diet with high unsaturated fat content to lower CV risk.<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n
Atherosclerotic cardiovascular disease risk reduction by glucose-lowering medications in diabetes\u2014Section 5.3<\/td>\n<\/tr>\n
Empagliflozin, canagliflozin, or
\ndapagliflozin \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho
\n\u0110T\u01102 k\u00e8m CVD, ho\u1eb7c tr\u00ean c\u00e1c b\u1ec7nh
\nnh\u00e2n c\u00f3 nguy c\u01a1 tim m\u1ea1ch cao\/r\u1ea5t cao
\n\u0111\u1ec3 gi\u1ea3m bi\u1ebfn c\u00f3 tim m\u1ea1ch.<\/td>\n		I<\/td>\nA<\/td>\nSGLT-2 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u1ee3i \u00edch tim m\u1ea1ch \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean \u0110T\u01102 k\u00e8m ASCVD \u0111\u1ec3 gi\u1ea3m bi\u1ebfn c\u1ed1 tim m\u1ea1ch, kh\u00f4ng ph\u1ee5
\nthu\u1ed9c HbA1C n\u1ec1n\/m\u1ee5c ti\u00eau v\u00e0 kh\u00f4ng ph\u1ee5 thu\u1ed9c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 \u0111ang d\u00f9ng<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u01102 kh\u00f4ng c\u00f3 ASCVD ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng n\u1eb7ng, nh\u01b0ng thang \u0111i\u1ec3m CVD-10 n\u0103m \u226510%, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng
\nSGLT2 ho\u1eb7c GLP-1 c\u00f3 th\u1ec3 xem x\u00e9t \u0111\u1ec3n gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch<\/td>\n		IIb<\/td>\nC<\/td>\n<\/tr>\n
Liraglutide,semaglutide,dulaglutide
\n\u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean \u0110T\u01102 k\u00e8m CVD
\nho\u1eb7c tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 tim
\nm\u1ea1ch cao\/r\u1ea5t cao \u0111\u1ec3 gi\u1ea3m bi\u1ebfn c\u00f3 tim
\nm\u1ea1ch.<\/td>\n		I<\/td>\nA<\/td>\nThu\u1ed1c GLP-1 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho \u0110T\u01102 v\u00e0 ASCVD \u0111\u1ec3 gi\u1ea3m bi\u1ebfn c\u1ed1 tim m\u1ea1ch, \u0111\u1ed9c l\u1eadp HbA1c n\u1ec1n\/m\u1ee5c ti\u00eau v\u00e0 c\u0169ng \u0111\u1ed9c l\u1eadp
\nv\u1edbi thu\u1ed1c \u0110H \u0111ang s\u1eed d\u1ee5ng<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean bn c\u00f3 \u0110T\u01102 kh\u00f4ng k\u00e8m ASCVD ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng n\u1eb7ng nh\u01b0ng c\u00f3 thang \u0111i\u1ec3m CVD-10 n\u0103m \u226510%, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng
\nSGLT2 ho\u1eb7c GLP-1 c\u00f3 th\u1ec3 xem x\u00e9t \u0111\u1ec3n gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch<\/td>\n		Iib<\/td>\nC<\/td>\n<\/tr>\n
Antithrombotic therapy in patients with diabetes\u2014Section 5.6<\/td>\n<\/tr>\n
Khi \u0111i\u1ec1u tr\u1ecb li\u1ec1u th\u1ea5p ASA, \u1ee9c ch\u1ebf b\u01a1m
\nproton n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t d\u00f9ng \u0111\u1ec3
\nph\u00f2ng ng\u1eeba xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y ru\u1ed9t<\/td>\n		IIa<\/td>\nA<\/td>\nKhi c\u00e1c thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p, \u1ee9c ch\u1ebf b\u01a1m proton \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba xu\u1ea5t
\nhuy\u1ebft d\u1ea1 d\u00e0y ru\u1ed9t<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Khi m\u1ed9t thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u ho\u1eb7c m\u1ed9t kh\u00e1ng \u0111\u00f4ng \u0111\u01a1n l\u1ebb \u0111\u01b0\u1ee3c
\ns\u1eed d\u1ee5ng, \u1ee9c ch\u1ebf b\u01a1m proton n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t d\u00f9ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y ru\u1ed9t, c\u00e2n nh\u1eafc nguy c\u01a1 xu\u1ea5t huy\u1ebft d\u1ef1a v\u00e0o t\u1eebng bn.<\/td>\n		IIa<\/td>\nA<\/td>\n<\/tr>\n
Heart failure and diabetes\u2014Section 7<\/td>\n<\/tr>\n
GLP-1 RA
\n(lixisenatide,liraglutide,semaglutide,exenatid
\ne,dulaglutide) c\u00f3 hi\u1ec7u qu\u1ea3 trung l\u1eadp tr\u00ean
\nnguy c\u01a1 suy tim nh\u1eadp vi\u1ec7n, v\u00e0 c\u00f3 th\u1ec3 xem x\u00e9t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb bn \u0110T\u0110 k\u00e8m suy tim<\/td>\n		IIb<\/td>\nA<\/td>\nGLP-1 RA (lixisenatide,liraglutide,semaglutide,exenatide
\nER,dulaglutide,efpeglenatide) c\u00f3 hi\u1ec7u qu\u1ea3 trung l\u1eadp tr\u00ean nguy c\u01a1 suy tim nh\u1eadp vi\u1ec7n, v\u00e0 c\u00f3 th\u1ec3 xem x\u00e9t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb bn \u0110T\u01102
\nk\u00e8m suy tim<\/td>\n		IIa<\/td>\nA<\/td>\n<\/tr>\n
Insulin c\u00f3 th\u1ec3 xem x\u00e9t tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n
\nv\u1edbi suy tim t\u00e2m thu EF gi\u1ea3m ti\u1ebfn tri\u1ec3n.<\/td>\n		IIb<\/td>\nC<\/td>\nInsulin n\u1ec1n (glargine v\u00e0 degludec) c\u00f3 hi\u1ec7u qu\u1ea3 trung l\u1eadp tr\u00ean nguy c\u01a1 suy tim nh\u1eadp vi\u1ec7n, v\u00e0 n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t cho \u0111i\u1ec1u tr\u1ecb
\n\u0110T\u01102 k\u00e8m suy tim ho\u1eb7c nguy c\u01a1 suy tim<\/td>\n		Iia<\/td>\nB<\/td>\n<\/tr>\n
Atrial fibrillation and diabetes\u2014Section 8.1<\/td>\n<\/tr>\n
T\u1ea7m so\u00e1t rung nh\u0129 b\u1eb1ng c\u00e1ch b\u1eaft m\u1ea1ch n\u00ean
\n\u0111\u01b0\u1ee3c l\u00e0m tr\u00ean bn>65 tu\u1ed5i v\u1edbi \u0110T\u0110 v\u00e0 x\u00e1c
\n\u0111\u1ecbnh b\u1eb1ng ECG, n\u1ebfu b\u1ea5t k\u1ef3 nghi ng\u1edd rung
\nnh\u0129, v\u00ec rung nh\u0129 t\u0103ng t\u1eed vong v\u00e0 t\u00e0n ph\u1ebf tr\u00ean
\n\u0110T\u0110<\/td>\n		IIa<\/td>\nC<\/td>\nT\u1ea7m so\u00e1t khi c\u00f3 c\u01a1 h\u1ed9i , rung nh\u0129 b\u1eb1ng c\u00e1ch b\u1eaft m\u1ea1ch ho\u1eb7c ECG \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c b\u1ec7nh nh\u00e2n \u2265 65 tu\u1ed5i<\/td>\nI<\/td>\nB<\/td>\n<\/tr>\n
Chronic kidney disease and diabetes\u2014Section 9<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng GLP-1 liraglutide v\u00e0
\nsemaglutide cho th\u1ea5y gi\u1ea3m nguy c\u01a1 \u0111i\u1ec3m c\u1eaft b\u1ec7nh th\u1eadn v\u00e0 n\u00ean c\u00e2n nh\u1eafc \u0111\u1ec3 s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 n\u1ebfu eGFR >30 mL\/min\/1.73 m2<\/td>\n		IIa<\/td>\nB<\/td>\nGLP-1 RA \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng t\u1ea1i m\u1ee9c eGFR >15 mL\/min\/1.73 m2 \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft, v\u00ec n\u00f3 c\u00f3 nguy c\u01a1 g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng th\u1ea5p v\u00e0 l\u1ee3i \u00edch tr\u00ean c\u00e2n n\u1eb7ng, tr\u00ean nguy c\u01a1 tim m\u1ea1ch v\u00e0 albumin ni\u1ec7u.<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3. Ch\u1ea9n \u0111o\u00e1n \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng b\u1ecb nghi ng\u1edd trong c\u00e1c t\u00ecnh hu\u1ed1ng \u0111\u1eb7c hi\u1ec7u, bao g\u1ed3m \u0103n nhi\u1ec1u, u\u1ed1ng nhi\u1ec1u, m\u1ec7t m\u1ecfi, m\u1edd m\u1eaft, t\u1ee5t c\u00e2n, v\u1ebft th\u01b0\u01a1ng l\u00e2u l\u00e0nh v\u00e0 nhi\u1ec5m khu\u1ea9n t\u00e1i \u0111i t\u00e1i l\u1ea1i. Tuy nhi\u00ean, c\u00f3 t\u1edbi 40% kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u00e0 b\u1ecb b\u1ecf s\u00f3t. Chuy\u1ec3n ho\u00e1 \u0111\u01b0\u1eddng b\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1ee3c chia v\u00e0o 2 m\u00f4 th\u1ee9c: \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 Ti\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.
\na. Ti\u00eau chu\u1ea9n v\u1ec1 x\u00e9t nghi\u1ec7m \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0110T\u0110 v\u00e0 ti\u1ec1n \u0110T\u0110
\ni. \u0110\u01b0\u1eddng huy\u1ebft \u0111\u00f3i:
\n\u0110\u01b0\u1eddng huy\u1ebft \u0111\u00f3i \u22657.0 mmol\/L (\u2265126 mg\/dL) l\u00e0 k\u1ebft qu\u1ea3 ch\u1ea9n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0110T\u0110,
\nm\u1eb7c d\u00f9 n\u00ean l\u00e0m 2 l\u1ea7n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3
\nch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh. C\u00f2n v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh th\u00ec 1 l\u1ea7n test l\u00e0 \u0111\u1ee7, v\u00e0 n\u00ean l\u01b0u \u00fd \u0111\u01b0\u1eddng \u0111\u00f3i l\u00e0 \u0111\u01b0\u1eddng nh\u1ecbn \u0103n \u00edt nh\u1ea5t 8 gi\u1edd.
\nTrong khi c\u00e1c guideline qu\u1ed1c t\u1ebf \u0111\u1ed3ng thu\u1eadn cho \u0111i\u1ec3m c\u1eaft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0110T\u0110, n\u00f3
\nl\u1ea1i ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c chia nh\u1ecf ra \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ti\u1ec1n \u0110T\u0110, theo WHO, ti\u1ec1n \u0110T\u0110 \u0111\u01b0uojc
\n\u0111\u1ecbnh ngh\u0129a khi m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft \u0111\u00f3i t\u1eeb 6.1\u20136.9 mmol\/L (110\u2013125 mg\/dL). Tuy
\nnhi\u00ean, hi\u1ec7p h\u1ed9i ADA l\u1ea1i nghi\u00eam ng\u1eb7t h\u01a1n, 5.6\u20136.9 mmol\/L (100\u2013125 mg\/dL) l\u00e0 \u0111\u00e3
\nch\u1ea9n \u0111o\u00e1n ti\u1ec1n \u0110T\u0110, v\u00e0 ch\u1ec9 nh\u1eefng ng\u01b0\u1eddi c\u00f3 m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft \u0111\u00f3i <5.6 mmol\/L
\n(<100 mg\/dL) m\u1edbi \u0111\u01b0\u1ee3c h\u1ecd xem l\u00e0 b\u00ecnh th\u01b0\u1eddng.<\/p>\n

ii. X\u00e9t nghi\u1ec7m dung n\u1ea1p glucose 2h v\u00e0 \u0111\u01b0\u1eddng ng\u1eabu nhi\u00ean:
\nSau 2h u\u1ed1ng 75g \u0111\u01b0\u1eddng, m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft \u226511.1 mmol\/L (\u2265200 mg\/dL) \u0111\u01b0\u1ee3c
\nxem l\u00e0 ch\u1ea9n \u0111o\u00e1n \u0110T\u0110, 7.8\u201311.0 mmol\/L (140\u2013199 mg\/dL) \u0111\u01b0\u1ee3c xem l\u00e0 t\u00ecnh
\ntr\u1ea1ng suy gi\u1ea3m dung n\u1ea1p \u0111\u01b0\u1eddng hay ti\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Tuy nhi\u00ean nghi\u1ec7m ph\u00e1p
\nn\u00e0y \u00edt d\u00f9ng do n\u00f3 b\u1ea5t ti\u1ec7n n\u00ean n\u00f3 ch\u1ec9 \u0111\u01b0\u1ee3c l\u00e0m tr\u00ean nh\u1eefng ca kh\u00f4ng r\u00f5 ch\u1ea9n \u0111o\u00e1n. Ti\u1ebfp theo, l\u00e0 \u0111\u01b0\u1eddng huy\u1ebft ng\u1eabu nhi\u00ean, tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng k\u00e8m m\u1ee9c \u0110H ng\u1eabu nhi\u00ean \u226511.1 mmol\/L (\u2265200 mg\/dL) s\u1ebd \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0110T\u0110. N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng th\u00ec c\u1ea7n 2 l\u1ea7n test \u0111\u01b0\u1eddng ng\u1eabu nhi\u00ean \u226511.1 mmol\/L (\u2265200 mg\/dL) m\u1edbi c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0110T\u0110.<\/p>\n

iii. Glycated haemoglobin
\nSau khi qua nhi\u1ec1u nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 ch\u1ea5t l\u01b0\u1ee3ng, \u0111\u1ec1 ngh\u1ecb r\u1eb1ng HbA1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0110T\u0110 v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o c\u00e1c guideline qu\u1ed1c t\u1ebf. HbA1c co c\u00e1c \u0111i\u1ec3m thu\u1eadn l\u1ee3i l\u00e0 d\u1ec5 \u0111o l\u01b0\u1eddng, \u00edt bi\u1ebfn thi\u00ean gi\u1eefa c\u00e1c c\u00e1 th\u1ec3, v\u00e0 c\u00f3 th\u1ec3 test b\u1ea5t k\u1ef3 th\u1eddi \u0111i\u1ec3m n\u00e0o. Tuy nhi\u00ean, n\u00f3 s\u1ebd kh\u00f4ng ch\u00ednh x\u00e1c tr\u00ean v\u00e0i nh\u00f3m ng\u01b0\u1eddi \u0111\u1eb7c bi\u1ec7t. Ch\u1eb3ng h\u1ea1n nh\u01b0 tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1 giai \u0111o\u1ea1n s\u1edbm, ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng tu\u1ef5 c\u1ea5p, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn HbA1c cho ra k\u1ebft qu\u1ea3 sai.
\nC\u00e1c guidelines \u0111\u1ec1u \u0111\u1ed3ng thu\u1eadn l\u1ea5y HbA1c \u226548 mmol\/mol (\u22656.5%) l\u00e0m \u0111i\u1ec3m c\u1eaft
\n\u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0110T\u0110, trong khi \u0111\u00f3, \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ti\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, ch\u00fang ta c\u00f3 2 \u0111i\u1ec3m c\u1eaft kh\u00e1c nhau (theo WHO l\u00e0 HbA1c 42\u201347 mmol\/mol (6.0\u20136.4%); theo
\nADA 39-47 mmol\/mol (5.7\u20136.4%))<\/p>\n

B\u1ea3ng: Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 ti\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng theo WHO v\u00e0 ADA (2021)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
X\u00e9t nghi\u1ec7m<\/td>\nTheo WHO<\/p>\n

(2011, 2019)<\/td>\n

Theo ADA<\/p>\n

(2021)<\/td>\n<\/tr>\n

\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\n<\/tr>\n
FPG<\/td>\n\u22657.0 mmol\/L (\u2265126 mg\/dL)<\/td>\n<\/tr>\n
2hPG (OGTT)<\/td>\n\u226511.1 mmol\/L (\u2265200 mg\/dL)<\/td>\n<\/tr>\n
HbA1c<\/td>\n\u22656.5% (\u226548 mmol\/mol)<\/td>\n<\/tr>\n
RPG<\/td>\n\u226511.1 mmol\/L (\u2265200 mg\/dL)<\/td>\n<\/tr>\n
<\/td>\nTi\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\n<\/tr>\n
FPG<\/td>\n6.1\u20136.9 mmol\/L
\n(110\u2013125 mg\/dL)<\/td>\n		5.6\u20136.9 mmol\/L
\n(100\u2013125 mg\/dL)<\/td>\n<\/tr>\n
2hPG (OGTT)<\/td>\n7.8\u201311.0 mmol\/L (140\u2013199 mg\/dL)<\/td>\n<\/tr>\n
HbA1c<\/td>\n6.0\u20136.4%
\n(42\u201347 mmol\/mol)<\/td>\n		5.7\u20136.4%
\n(39\u201347 mmol\/mol)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/div>\n
\"ESC<\/a>
L\u01b0u \u0111\u1ed3: ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 ti\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng theo ti\u00eau chu\u1ea9n c\u1ee7a ADA.<\/figcaption><\/figure>\n

4. Ph\u00e2n lo\u1ea1i \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

4.1. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1<\/h3>\n

Chi\u1ebfm 5-10% s\u1ed1 ng\u01b0\u1eddi b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nguy\u00ean nh\u00e2n l\u00e0 do s\u1ef1 ph\u00e1 hu\u1ef7 c\u1ea5u tr\u00fac t\u1ebf b\u00e0o beta tu\u1ef5 do t\u1ef1 mi\u1ec5n, d\u1eabn \u0111\u1ebfn thi\u1ebfu h\u1ee5t insulin. Nhi\u1ec1u guideline \u0111\u00e3 c\u00f4ng b\u1ed1 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n
\nPh\u1ea7n l\u1edbn, khi b\u1ec7nh nh\u00e2n <35 tu\u1ed5i m\u00e0 m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng th\u00ec n\u00ean nghi ng\u1edd type 1, m\u1eb7c d\u00f9 n\u00f3 c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u1ef3 l\u1ee9a tu\u1ed5i n\u00e0o. H\u1ecfi b\u1ec7nh s\u1eed n\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u v\u00e0 m\u1ea5t c\u00e2n tr\u00ean b\u1ec7nh nh\u00e2n tr\u1ebb th\u00ec n\u00ean nghi ng\u1edd l\u00e0 \u0110T\u0110 1. X\u00e9t nghi\u1ec7m m\u00e1u t\u00ecm kh\u00e1ng th\u1ec3 s\u1ebd gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, m\u1eb7c d\u00f9 n\u00f3 c\u00f3 th\u1ec3 \u00e2m t\u00ednh gi\u1ea3 \u1edf 5-10% b\u1ec7nh nh\u00e2n, x\u00e9t nghi\u1ec7m C-peptide gi\u00fap \u0111\u00e1nh gi\u00e1 s\u1ea3n xu\u1ea5t insulin n\u1ed9i sinh tr\u00ean c\u00e1c ca kh\u00f4ng r\u00f5 r\u00e0ng.<\/p>\n

4.2. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/h3>\n

Chi\u1ebfm 90% b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, v\u00e0 th\u01b0\u1eddng do t\u00ecnh tr\u1ea1ng \u0111\u1ec1 kh\u00e1ng insulin, k\u1ebft h\u1ee3p v\u1edbi gi\u1ea3m s\u1ea3n xu\u1ea5t insulin t\u01b0\u01a1ng \u0111\u1ed1i, h\u1eadu qu\u1ea3 l\u00e0 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft. \u0110T\u01102 c\u00f3 th\u1ec3 kh\u00f4ng tri\u1ec7u ch\u1ee9ng cho \u0111\u1ebfn khi bi\u1ebfn ch\u1ee9ng xu\u1ea5t hi\u1ec7n. Do v\u1eady, t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch \u0111\u1ec1u b\u1eaft bu\u1ed9c ph\u1ea3i t\u1ea7m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

4.3. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng th\u1ee9 ph\u00e1t v\u00e0 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft do stress<\/h3>\n

\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u00f3 th\u1ec3 th\u1ee9 ph\u00e1t do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng do stress th\u01b0\u1eddng s\u1ebd hay g\u1eb7p tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u1ed9i vi\u1ec7n, v\u00e0 c\u00f3 th\u1ec3 g\u1eb7p tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p, ho\u1eb7c suy tim. T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft do stress n\u00ean nghi ng\u1edd tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u1ed9i vi\u1ec7n c\u00f3 t\u0103ng glucose m\u00e1u, m\u00e0 HbA1c v\u1eabn b\u00ecnh th\u01b0\u1eddng. C\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y n\u00ean
\nl\u00e0m x\u00e9t nghi\u1ec7m OGTT sau v\u00e0i tu\u1ea7n \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc khi xu\u1ea5t vi\u1ec7n \u0111\u1ec3 lo\u1ea1i tr\u1eeb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c suy dung nap \u0111\u01b0\u1eddng, nh\u01b0ng d\u1eef li\u1ec7u h\u1ed7 tr\u1ee3 cho c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y c\u00f2n h\u1ea1n ch\u1ebf.<\/p>\n

4.4. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3<\/h3>\n

\u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong tam c\u00e1 nguy\u1ec7t 2 v\u00e0 3 m\u00e0 tr\u01b0\u1edbc \u0111\u00f3 kh\u00f4ng b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Trong khi hi\u1ec7n t\u1ea1i ch\u01b0a c\u00f3 1 \u0111\u1ed3ng thu\u1eadn n\u00e0o v\u1ec1 chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn t\u1ed1t nh\u1ea5t cho \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3, Chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn 1 b\u01b0\u1edbc \u201cone step\u201d c\u1ee7a WHO b\u1eb1ng u\u1ed1ng 75g \u0111\u01b0\u1eddng,hi\u1ec7n nay \u0111\u01b0\u1ee3c nhi\u1ec1u n\u01b0\u1edbc \u00e1p d\u1ee5ng. X\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng huy\u1ebft l\u1ea1i sau thai k\u1ef3, \u0111\u1ec3 lo\u1ea1i tr\u1eeb t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft k\u00e9o d\u00e0i v\u00e0 c\u0169ng n\u00ean x\u00e9t nghi\u1ec7m l\u1ea1i h\u1eb1ng n\u0103m v\u00ec \u0111\u00e2y c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng nguy c\u01a1 d\u1ec5 b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. C\u0169ng v\u1eady, c\u00e1c b\u1eb1ng ch\u1ee9ng ch\u1ec9 ra r\u1eb1ng c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3, t\u0103ng nguy c\u01a1 tim m\u1ea1ch d\u00f9 sau thai k\u1ef3 \u0111\u01b0\u1eddng huy\u1ebft tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng. Ch\u00ednh v\u00ec v\u1eady ngo\u00e0i t\u1ea7m so\u00e1t nguy c\u01a1 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u0169ng c\u1ea7n n\u00ean
\nt\u1ea7m so\u00e1t s\u1ee9c kho\u1ebb tim m\u1ea1ch.<\/p>\n

5. T\u1ea7m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

Ti\u00eau chu\u1ea9n x\u00e9t nghi\u1ec7m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thay \u0111\u1ed5i tu\u1ef3 n\u01a1i, v\u00e0 vi\u1ec7c th\u1ed1ng nh\u1ea5t ti\u00eau chu\u1ea9n t\u1ed1t nh\u1ea5t v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u1ed3ng thu\u1eadn. Nh\u00ecn chung, \u0111a s\u1ed1 \u0111\u1ed3ng thu\u1eadn, tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n nguy c\u01a1 cao (nh\u01b0 nh\u1eefng ng\u01b0\u1eddi b\u00e9o ph\u00ec hay ng\u01b0\u1eddi c\u00f3 \u0111\u1ec1 kh\u00e1ng insulin nh\u01b0 gan nhi\u1ec5m m\u1ee1) n\u00ean \u0111\u01b0\u1ee3c t\u1ea7m so\u00e1t th\u01b0\u1eddng xuy\u00ean, \u0111\u1eb7c bi\u1ec7t khi h\u1ecd tr\u00ean 45 tu\u1ed5i. H\u1ed9i ADA x\u00e2y d\u01b0nhj m\u1ed9t b\u1ea3ng t\u1ea7m so\u00e1t g\u1ed3m 7 ti\u00eau ch\u00ed bao g\u1ed3m: tu\u1ed5i, gi\u1edbi, c\u00e2n n\u1eb7ng, v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c, ti\u1ec1n s\u1eed \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thai k\u1ef3, t\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p, v\u00e0 b\u1ec7nh s\u1eed \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng gia \u0111\u00ecnh, khi th\u00e1ng \u0111i\u1ec3m n\u00e0y cho ra k\u1ebft qu\u1ea3 \u22655\u0111, th\u00ec ADA khuy\u1ebfn c\u00e1o n\u00ean th\u1ef1c hi\u1ec7n t\u1ea7m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng cho b\u1ec7nh nh\u00e2n.
\nT\u1ea7n su\u1ea5t m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u0103ng theo b\u1ec7nh l\u00fd tim m\u1ea1ch, t\u1ef7 l\u1ec7 l\u00e0 23-37%, v\u00e0 c\u00f3 10-47% suy tim \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u00f3 m\u1eafc k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. K\u1ebft c\u1ee5c s\u1ebd t\u1ec7 h\u01a1n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y so v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n tim m\u1ea1ch nh\u01b0ng kh\u00f4ng r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 \u0111\u01b0\u1eddng. Do \u0111\u00f3, c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh m\u1ea1ch v\u00e0nh x\u01a1 v\u1eefa v\u00e0\/ho\u1eb7c suy tim v\u00e0\/ho\u1eb7c rung nh\u0129, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eebng nh\u1eadp vi\u1ec7n v\u1edbi c\u00e1c \u0111\u1ee3t c\u1ea5p c\u1ee7a b\u1ec7nh tim m\u1ea1ch \u1ea5y, c\u00e0ng c\u1ea7n ph\u1ea3i t\u1ea7m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng; \u0111\u1ed1i v\u1edbi
\nc\u00e1c b\u1ec7nh nh\u00e2n t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft do stress (t\u1ee9c l\u00e0 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft l\u00fac nh\u1eadp vi\u1ec7n nh\u01b0ng H\u00e21c
\nb\u00ecnh th\u01b0\u1eddng) n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 test l\u1ea1i \u0111\u01b0\u1eddng sau khi xu\u1ea5t vi\u1ec7n, \u01b0u ti\u00ean ph\u01b0\u01a1ng ph\u00e1p OGTT, \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c chuy\u1ec3n ho\u00e1 b\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1eddng huy\u1ebft k\u00e9o d\u00e0i.
\nM\u1eb7c d\u00f9 tr\u01b0\u1edbc \u0111\u00e2y, ph\u01b0\u01a1ng ph\u00e1p OGTT \u0111\u01b0\u1ee3c \u1eedng h\u1ed9 \u0111\u1ec3 t\u1ea7m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nh\u01b0ng test n\u00e0y hi\u1ec7n v\u1eabn \u0111ang \u0111\u01b0\u1ee3c s\u1ee7 d\u1ee5ng v\u1edbi s\u1ed1 l\u01b0\u1ee3ng \u00edt. Quan tr\u1ecdng c\u1ea7n nh\u1ea5n m\u1ea1nh l\u00e0 HbA1c ho\u1eb7c \u0111\u01b0\u1eddng \u0111\u00f3i, l\u00e0 c\u00e1c th\u00f4ng s\u1ed1 m\u1ea1nh h\u01a1n trong ti\u00ean l\u01b0\u1ee3ng c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u khi so s\u00e1nh v\u1edbi ph\u01b0\u01a1ng ph\u00e1p OGTT sau 2h, v\u00e0 n\u00f3 c\u0169ng ti\u1ec7n l\u1ee3i h\u01a1n nhi\u1ec1u.<\/p>\n

Recommendation Table 1 \u2014 Recommendations for diagnosing diabetes<\/strong><\/p>\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
T\u1ea7m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3
\nb\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch, s\u1eed d\u1ee5ng test \u0111\u01b0\u1eddng \u0111\u00f3i
\nv\u00e0\/ho\u1eb7c HbA1c<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng d\u1ef1a tr\u00ean HbA1c
\nv\u00e0\/ho\u1eb7c m\u1ee9c \u0111\u01b0\u1eddng \u0111\u00f3i, ho\u1eb7c d\u1ef1a tr\u00ean OGTT n\u1ebfu v\u1eabn
\nc\u00f2n nghi ng\u1edd m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

6. \u0110\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/h2>\n

C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u0103ng nguy c\u01a1 t\u1eeb 2-4 l\u1ea7n vi\u1ec7c m\u1eafc c\u00e1c b\u1ec7nh tim m\u1ea1ch, m\u00e0 c\u00f3 bi\u1ec3u hi\u1ec7n b\u1eb1ng b\u1ec7nh m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ecb, suy tim v\u00e0 rung nh\u0129 c\u0169ng nh\u01b0 b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean. C\u1ea7n b\u1ed5 sung th\u00eam, c\u00f3 nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch nh\u01b0ng kh\u00f4ng l\u00e0m x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1eb7c d\u00f9 h\u1ecd \u0111\u00e3 m\u1eafc.<\/p>\n

6.1. \u0110\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/h3>\n

Khi \u0111\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch, qu\u1ea1n trong c\u1ea7n l\u01b0u \u00fd ti\u1ec1n s\u1eed b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh, tri\u1ec7u ch\u1ee9ng, x\u00e9t nghi\u1ec7m, t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch n\u1eb7ng. T\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch m\u1ee9c \u0111\u1ed9 n\u1eb7ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 sau:
\n1. eGFR <45 mL\/min\/1.73 m cho d\u00f9 c\u00f3 albumin ni\u1ec7u hay kh\u00f4ng HO\u1eb6C
\n2. eGFR 45\u201359 mL\/min\/1.73 m2 k\u00e8m theo ti\u1ec3u albumin vi th\u1ec3 (UACR 30-300 mg\/g;
\ngiai \u0111o\u1ea1n A2), HO\u1eb6C
\n3. Ti\u1ec3u \u0111\u1ea1m \u0111\u1ea1i th\u1ec3 (UACR >300 mg\/g; giai \u0111o\u1ea1n A3) HO\u1eb6C
\n4. Ho\u1eb7c s\u1eed hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ec7nh l\u00fd vi m\u1ea1ch m\u00e1u \u1edf \u00edt nh\u1ea5t 3 v\u1ecb tr\u00ed kh\u00e1c nhau (v\u00ed d\u1ee5 ti\u1ec3u \u0111\u1ea1m vi th\u1ec3 k\u00e8m b\u1ec7nh l\u00fd v\u00f5ng m\u1ea1c k\u00e8m v\u1edbi b\u1ec7nh l\u00fd th\u1ea7n kinh).<\/p>\n

6.2. Ph\u00e2n lo\u1ea1i nguy c\u01a1 tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/h3>\n

Table 7 Cardiovascular risk categories in type 2 diabetes<\/strong><\/p>\n\n\n\n\n\n\n
Very high CV
\nrisk<\/td>\n		B\u1ec7nh nh\u00e2n v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 k\u00e8m:
\n– B\u1ec7nh tim m\u1ea1ch x\u01a1 v\u1eefa ho\u1eb7c
\n– T\u1ed5n th\u01b0\u01a1ng t\u1ea1ng n\u1eb7ng ho\u1eb7c
\n– \u0110i\u1ec3m nguy c\u01a1 CVD-10 n\u0103m \u2265 20% (thang \u0111i\u1ec3m SCORE2-
\ndiabetes)<\/td>\n<\/tr>\n
High CV risk<\/td>\nB\u1ec7nh nh\u00e2n v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n nguy c\u01a1 r\u1ea5t cao k\u00e8m theo
\n– \u0110i\u1ec3m nguy c\u01a1 CVD-10 n\u0103m 10-20 % (thang \u0111i\u1ec3m SCORE2-
\ndiabetes)<\/td>\n<\/tr>\n
Moderate CV
\nrisk<\/td>\n		B\u1ec7nh nh\u00e2n v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n nguy c\u01a1 r\u1ea5t cao k\u00e8m theo
\n– \u0110i\u1ec3m nguy c\u01a1 CVD-10 n\u0103m 5-10 % (thang \u0111i\u1ec3m SCORE2-
\ndiabetes)<\/td>\n<\/tr>\n
Low CV risk<\/td>\nB\u1ec7nh nh\u00e2n v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n nguy c\u01a1 r\u1ea5t cao k\u00e8m theo
\n– \u0110i\u1ec3m nguy c\u01a1 CVD-10 n\u0103m < 5% (thang \u0111i\u1ec3m SCORE2-diabetes)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

6.3. N\u00f3i v\u1ec1 thang \u0111i\u1ec3m SCORE2-Diabetes: \u01b0\u1edbc t\u00ednh nguy c\u01a1 tim m\u1ea1ch trong 10 n\u0103m<\/h3>\n

Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u2265 40 tu\u1ed5i kh\u00f4ng k\u00e8m theo b\u1ec7nh tim m\u1ea1ch x\u01a1 v\u1eefa hay t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng n\u1eb7ng, khuy\u1ebfn c\u00e1o n\u00ean \u01b0\u1edbc tinh nguy c\u01a1 tim m\u1ea1ch 10 n\u0103m b\u1eb1ng thang \u0111i\u1ec3m SCORE2- diabetes (l\u01b0u \u0111\u1ed3). V\u00e0o n\u0103m 2021, c\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a ESC v\u1ec1 vi\u1ec7c ph\u00f2ng ng\u1eeba c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch, trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, hai nghi\u00ean c\u1ee9u l\u1edbn l\u00e0 ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN MR Controlled Evaluation) ho\u1eb7c DIAL (Diabetes lifetimeperspective prediction) \u0111\u1ec1u \u0111\u1ec1 ngh\u1ecb n\u00ean \u01b0\u1edbc t\u00ednh nguy c\u01a1 tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, tuy nhi\u00ean v\u00ec v\u00e0i l\u00fd do, n\u00f3 \u0111\u00e3 b\u1ecb h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng t\u1ea1i Ch\u00e2u \u00c2u (v\u00ec c\u00e1c ti\u00eau chu\u1ea9n n\u00ean ch\u00fang \u01b0\u1edbc t\u00ednh kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi d\u00e2n c\u01b0 Ch\u00e2u \u00c2u).
\nCh\u00ednh v\u00ec \u0111i\u1ec1u \u0111\u00f3 c\u00e1c khuy\u1ebfn c\u00e1o hi\u1ec7n h\u00e0nh khuy\u00ean d\u00f9ng thang \u0111i\u1ec3m SCORE2-Diabetes.<\/p>\n

\"ESC<\/a><\/p>\n

Recommendation Table 2 \u2014 Recommendations for assessing cardiovascular risk in patients with type 2 diabetes<\/strong><\/p>\n\n\n\n\n\n\n
Recommendations to assess cardiovascular risk in patients with diabetes<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o n\u00ean t\u1ea7m so\u00e1t t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng n\u1eb7ng tr\u00ean
\nc\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o n\u00ean \u0111\u00e1nh gi\u00e1 ti\u1ec1n s\u1eed v\u00e0 tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd
\nb\u1ec7nh tim m\u1ea1ch x\u01a1 v\u1eefa tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102 kh\u00f4ng c\u00f3 b\u1ec7nh tim m\u1ea1ch x\u01a1
\nv\u1eefa c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng n\u1eb7ng,
\nkhuy\u1ebfn c\u00e1o n\u00ean \u0111\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch b\u1eb1ng<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

<\/h2>\n

7. Gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: m\u1ee5c ti\u00eau v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb<\/h2>\n

7.1. L\u1ed1i s\u1ed1ng<\/h3>\n

M\u1ed9t nghi\u00ean c\u1ee9u mang t\u00ean Action for Health in Diabetes trial (Look AHEAD; 5145
\nT2DM patients, 59% female, mean age 58 years, mean body mass index
\n[BMI] 36 kg\/m2), \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng, vi\u1ec7c gi\u1ea3m trung b\u00ecnh 8.6% c\u00e2n n\u1eb7ng, s\u1ebd t\u1ea1o ra vi\u1ec7c gi\u1ea3m \u0111\u00e1ng k\u1ec3 HbA1c v\u00e0 huy\u1ebft \u00e1p. Vi\u00eac gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng m\u1ee1 trong c\u01a1 th\u1ec3 c\u0169ng l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 nguy c\u01a1 m\u1eafc suy tim<\/p>\n

7.2. Gi\u1ea3m c\u00e2n<\/h3>\n

Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng k\u00e8m theo b\u00e9o ph\u00ec, gi\u1ea3m c\u00e2n ch\u00ednh l\u00e0 n\u1ec1n t\u1ea3ng c\u1ed1t y\u1ebfu c\u1ee7a \u0111i\u1ec1u tr\u1ecb. Ch\u1ec9 c\u1ea7n gi\u1ea3m >5% c\u00e2n n\u1eb7ng l\u00e0 \u0111\u00e3 c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng huy\u1ebft, huy\u1ebft \u00e1p, m\u1ee1 m\u00e1u. Hi\u1ec7u qu\u1ea3 n\u00e0y c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng ch\u1ec9nh l\u1ea1i l\u1ed1i s\u1ed1ng v\u00e0\/ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh. Orlistat, naltrexone\/bupropion, v\u00e0 phentermine\/topiramate l\u00e0 c\u00e1c thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh gi\u1ea3m >5% c\u00e2n n\u1eb7ng \u1edf tu\u1ea7n th\u1ee9 52 khi so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c.
\nTuy nhi\u00ean, thu\u1ed1c GLP-1 Ras, c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 gi\u1ea3m c\u00e2n r\u00f5 r\u1ec7t v\u00e0 c\u0169ng gi\u00fap h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. Khi k\u00e8m theo t\u1eadp luy\u1ec7n m\u00e0 d\u00f9ng thu\u1ed1c GLP-1 (Liraglutide), s\u1ebd t\u1ea1o ra hi\u1ec7u qu\u1ea3 gi\u1ea3m c\u00e2n v\u00e0 duy tr\u00ec c\u00e2n n\u1eb7ng \u0111\u00e1ng k\u1ec3.<\/p>\n

Recommendation Table 3 \u2014 Recommendations for reducing weight in patients with type 2 diabetes with or without cardiovascular disease<\/strong><\/p>\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o t\u1eadp luy\u1ec7n \u0111\u1ec3 gi\u1ea3m c\u00e2n, c\u1ea3i thi\u1ec7n
\nki\u1ec3m so\u00e1t chuy\u1ec3n ho\u00e1 v\u00e0 nguy c\u01a1 tim m\u1ea1ch<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Thu\u1ed1c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft k\u00e8m t\u00e1c \u0111\u1ed9ng l\u00ean
\nc\u00e2n n\u1eb7ng (vd GLP-1) n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u00f9ng
\ncho c\u00e1c b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec hay qu\u00e1 c\u00e2n<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n
Ph\u1eabu thu\u1eadt d\u1ea1 d\u00e0y ru\u1ed9t cho c\u00e1c b\u1ec7nh nh\u00e2n
\nBMI\u226535 k\u00e8m nguy c\u01a1 cao hay r\u1ea5t cao, khi thay
\n\u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p thu\u1ed1c gi\u1ea3m c\u00e2n kh\u00f4ng \u0111\u1ea1t
\nk\u1ebft qu\u1ea3.<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

7.3. M\u1ee5c ti\u00eau \u0111\u01b0\u1eddng huy\u1ebft<\/h3>\n

Recommendation Table 7 \u2014 Recommendations for glycaemic targets in patients with diabetes<\/strong><\/p>\n\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o n\u00ean ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft ch\u1eb7t
\n(HbA1c<7%) \u0111\u1ec3 gi\u1ea3m c\u00e1c bi\u1ebfn ch\u1ee9ng vi m\u1ea1ch m\u00e1u<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o n\u00ean tr\u00e1nh t\u1ee5t \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u1eb7c bi\u1ec7t
\ntr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o n\u00ean c\u00e1c nh\u00e2n ho\u00e1 HbA1c, d\u1ef1a v\u00e0o
\nb\u1ec7nh \u0111\u1ed3ng m\u1eafc, th\u1eddi gian m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, v\u00e0
\nd\u1ef1 h\u1eadu th\u1eddi gian s\u1ed1ng<\/td>\n		I<\/td>\nC<\/td>\n<\/tr>\n
Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft ch\u1eb7t ch\u1ebd n\u00ean xem x\u00e9t \u0111\u1ec3
\ngi\u1ea3m b\u1ec7nh l\u00fd tim m\u1ea1ch, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c c\u00f3 l\u1ee3i
\ntim m\u1ea1ch \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

\"ESC<\/a>
ESC 2023 H\u01af\u1edaNG D\u1eaaN \u0110I\u1ec0U TR\u1eca B\u1ec6NH L\u00dd TIM M\u1ea0CH
TR\u00caN B\u1ec6NH NH\u00c2N C\u00d3 \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG<\/figcaption><\/figure>\n

8. Gi\u1ea3m nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch x\u01a1 v\u1eefa b\u1eb1ng c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/h2>\n

\"L\u01b0u<\/a><\/p>\n

\"ESC<\/a><\/p>\n

Recommendation Table 8 \u2014 Recommendations for glucose-lowering treatment for patients with type 2 diabetes and atherosclerotic cardiovascular disease to reduce cardiovascular risk<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c h\u1ea1 \u0110H \u0111\u00e3
\n\u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 l\u1ee3i tim m\u1ea1ch, sau \u0111\u00f3
\nm\u1edbi \u0111\u1ebfn c\u00e1c thu\u1ed1c an to\u00e0n tim m\u1ea1ch, h\u01a1n l\u00e0
\ns\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh<\/td>\n		I<\/td>\nC<\/td>\n<\/tr>\n
Sodium\u2013glucose co-transporter-2 inhibitors<\/td>\n<\/tr>\n
Thu\u1ed1c SGLT-2 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho
\nb\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m b\u1ec7nh tim m\u1ea1ch x\u01a1
\nv\u1eefa, \u0111\u1ed9c l\u1eadp v\u1edbi m\u1ee9c HbA1c m\u1ee5c ti\u00eau v\u00e0 \u0111\u1ed9c
\nl\u1eadp v\u1edbi c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng \u0111\u1ed3ng s\u1eed d\u1ee5ng.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Glucagon-like peptide-1 receptor agonists<\/td>\n<\/tr>\n
Thu\u1ed1c GLP-1 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho
\nb\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m b\u1ec7nh tim m\u1ea1ch x\u01a1
\nv\u1eefa, \u0111\u1ed9c l\u1eadp v\u1edbi m\u1ee9c HbA1c m\u1ee5c ti\u00eau v\u00e0 \u0111\u1ed9c
\nl\u1eadp v\u1edbi c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng \u0111\u1ed3ng s\u1eed d\u1ee5ng.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Other glucose-lowering medications to reduce cardiovascular risk<\/td>\n<\/tr>\n
N\u1ebfu c\u1ea7n th\u00eam thu\u1ed1c h\u1ea1 \u0110H, Metformin n\u00ean
\n\u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u00f9ng t\u00ean \u0110T\u01102 k\u00e8m b\u1ec7nh tim
\nm\u1ea1ch x\u01a1 v\u1eefa<\/td>\n		IIa<\/td>\nC<\/td>\n<\/tr>\n
N\u1ebfu c\u1ea7n th\u00eam thu\u1ed1c h\u1ea1 \u0110H, Pioglitazone n\u00ean
\n\u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u00f9ng t\u00ean \u0110T\u01102 k\u00e8m b\u1ec7nh tim
\nm\u1ea1ch x\u01a1 v\u1eefa nh\u01b0ng kh\u00f4ng suy tim<\/td>\n		IIb<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

9. Huy\u1ebft \u00e1p v\u00e0 b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

9.1. T\u1ea7m so\u00e1t v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h3>\n

\u0110o huy\u1ebft \u00e1p th\u01b0\u1eddng xuy\u00ean l\u00e0 \u0111i\u1ec1u b\u1eaft bu\u1ed9c tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110. Ch\u1ea9n \u0111o\u00e1n cao huy\u1ebft \u00e1p n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf c\u1ea3 2 tay v\u00e0 qua nhi\u1ec1u ng\u00e0y \u0111o. Ri\u00eang c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch k\u00e8m HA >180\/110 mmHg th\u00ec c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n ngay l\u1eadp t\u1ee9c ch\u1ec9 v\u1edbi 1 l\u1ea7n \u0111o. Chi ti\u1ebft v\u1ec1 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 trong h\u01b0\u1edbng d\u1eabn c\u1ee7a ESH n\u0103m 2018.<\/p>\n

\"ESC<\/a><\/p>\n

9.2. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h3>\n

C\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean \u0111\u00e3 cho th\u1ea5y l\u1ee3i \u00edch (gi\u1ea3m \u0111\u1ed9t qu\u1ecb, bi\u1ebfn c\u1ed1 m\u1ea1ch v\u00e0nh v\u00e0 b\u1ec7nh th\u1eadn) vi\u1ec7c gi\u1ea3m Ha t\u00e2m thu <140 mmHg v\u00e0 huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng <90 mmHg tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110. Tuy nhi\u00ean huy\u1ebft \u00e1p l\u00fd t\u01b0\u1edfng nh\u1ea5t th\u00ec v\u1eabn c\u00f2n \u0111ang b\u1ecb tranh c\u00e3i. Trong m\u1ed9t nghi\u00ean c\u1ee9u ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p RCT tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u0110 v\u00e0 ti\u1ec1n \u0110T\u0110, vi\u1ec7c gi\u1ea3m Ha t\u00e2m thu \u2264135 mmHg so v\u1edbi vi\u1ec7c ki\u1ec3m so\u00e1t \u00edt ch\u1eb7t ch\u1ebd h\u01a1n , s\u1ebd l\u00e0m gi\u1ea3m nguy c\u01a1 t\u1eed vong do t\u1ea5t c\u1ea3 c\u00e1c nguy\u00ean nh\u00e2n v\u1edbi t\u1ef7 l\u1ec7 gi\u1ea3m l\u00e0 10%. Ng\u01b0\u1ee3c l\u1ea1i, ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p ch\u1eb7t h\u01a1n (\u2264130 mmHg) s\u1ebd l\u00e0m gi\u1ea3m r\u00f5 nguy c\u01a1 \u0111\u1ed9t qu\u1ecb nh\u01b0ng kh\u00f4ng thay \u0111\u1ed5i c\u00e1c nguy c\u01a1 kh\u00e1c. Nh\u01b0ng m\u1ed9t \u0111i\u1ec1u ch\u1eafc ch\u1eafn r\u1eb1ng vi\u1ec7c huy\u1ebft \u00e1p SBP >140 mmHg ho\u1eb7c <120 mmHg s\u1ebd d\u1eabn \u0111\u1ebfn t\u1ef7 l\u1ec7 cao c\u00e1c bi\u1ebfn c\u1ed1 b\u1ec7nh th\u1eadn n\u1eb7ng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u0110.<\/p>\n

H\u01b0\u1edbng d\u1eabn c\u1ee7a ESC\/ESH 2018 khuy\u1ebfn c\u00e1o t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o
\n\u0111\u01b0\u1eddng n\u00ean \u0111\u1eb7t m\u1ee5c ti\u00eau huy\u1ebft \u00e1p t\u00e2m thu l\u00e0 130mmHg v\u00e0 th\u1ea5p h\u01a1n n\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ea5p h\u01a1n 120 mmHg; c\u00f2n huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng n\u00ean th\u1ea5p h\u01a1n 80mmHg nh\u01b0ng kh\u00f4ng n\u00ean th\u1ea5p qu\u00e1 70mmHg. V\u1edbi \u0111\u1ed1i t\u01b0\u1ee3ng ng\u01b0\u1eddi cao tu\u1ed5i (\u226565 tu\u1ed5i), huy\u1ebft \u00e1p t\u00e2m thu n\u00ean ch\u1ea1y t\u1eeb 130-140mmHg n\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p. Tuy nhi\u00ean nhi\u1ec1u d\u1eef li\u1ec7u \u0111\u00e3 quay l\u1ea1i th\u00e1ch th\u1ee9c khuy\u1ebfn c\u00e1o n\u00e0y, v\u00e0 nh\u1ea5n m\u1ea1nh h\u01a1n vi\u1ec7c c\u00e1 nh\u00e2n ho\u00e1 m\u1ee9c huy\u1ebft \u00e1p tr\u00ean t\u1eebng
\nb\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i. H\u01b0\u1edbng d\u1eabn n\u0103m 2021 c\u1ee7a ESC khuy\u1ebfn c\u00e1o m\u1ee9c huy\u1ebft \u00e1p t\u00e2m thu m\u1ee5c ti\u00eau tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng n\u00ean trong ng\u01b0\u1ee1ng 120-130 mmHg, v\u00e0 c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n n\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p (ch\u1ec9 \u00e1p d\u1ee5ng cho c\u00e1c b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 69 tu\u1ed5i). Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n t\u1eeb 70 tu\u1ed5i tr\u1edf l\u00ean, huy\u1ebft \u00e1p t\u00e2m thu <140 mmHg, v\u00e0 d\u01b0\u1edbi 130 mmHg n\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p. M\u1ee5c ti\u00eau huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng <80 mmHg \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n.<\/p>\n

9.3. \u0110i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/h3>\n

Trong nghi\u00ean c\u1ee9u ph\u00e2n t\u00edch h\u1eadu ki\u1ec3m PARAGON-HF [Efficacy and Safety of LCZ696 so s\u00e1nh thu\u1ed1c Valsartan, d\u1ef1a tr\u00ean t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 t\u00e0n ph\u1ebf \u1edf b\u1ec7nh nh\u00e2n suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n, ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y r\u1eb1ng
\nsacubitril\/valsartan gi\u00fap ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u1ed1t h\u01a1n nhi\u1ec1u khi d\u00f9ng valsartan \u0111\u01a1n \u0111\u1ed9c<\/p>\n

9.3.1. Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 gi\u1ea3m c\u00e2n
\n9.3.2. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c
\nN\u1ebfu t\u1ea1i ph\u00f2ng m\u1ea1ch huy\u1ebft \u00e1p t\u00e2m thu \u2265140 mmHg v\u00e0\/ho\u1eb7c HA t\u00e2m tr\u01b0\u01a1ng \u226590 mmHg. \u0110i\u1ec1u tr\u1ecb thu\u1ed1c l\u00e0 c\u1ea7n thi\u1ebft v\u00e0 n\u00ean k\u1ebft h\u1ee3p v\u1edbi thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 s\u1ed1ng. T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng \u0111\u1ec1u c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng nh\u01b0ng c\u00e1c b\u1eb1ng ch\u1ee9ng khuy\u1ebfn c\u00e1o \u01b0u ti\u00ean d\u00f9ng thu\u1ed1c nh\u00f3m \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, \u0111\u1eb7c bi\u1ec7t tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch (ti\u1ec3u \u0111\u1ea1m ho\u1eb7c ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i). Tuy nhi\u00ean, trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ec9 ra thu\u1ed1c Ha nh\u00f3m \u1ee9c ch\u1ebf h\u1ec7 renin- angiotensin (RAS) kh\u00f4ng v\u01b0\u1ee3t h\u01a1n c\u00e1c nh\u00f3m thu\u1ed1c Ha kh\u00e1c trong gi\u1ea3m
\nc\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch c\u0169ng nh\u01b0 th\u1eadn.
\nKi\u1ec3m so\u00e1t huy\u1ebft \u00e1p th\u01b0\u1eddng \u0111\u00f2i h\u1ecfi \u0111a thu\u1ed1c nh\u01b0 RAS k\u1ebft h\u1ee3p v\u1edbi amlodipine ho\u1eb7c l\u1ee3i ti\u1ec3u. C\u00e2n nh\u1eafc b\u1ed5 sung th\u00eam beta-blocker ngay khi ph\u00e1t hi\u1ec7n: suy tim, \u0111au th\u1eaft ng\u1ef1c, rung nh\u0129, sau nh\u1ed3i m\u00e1u c\u01a1 tim, ho\u1eb7c b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i \u0111ang ho\u1eb7c s\u1ebd c\u00f3 thai. S\u1eed d\u1ee5ng vi\u00ean \u0111\u01a1n k\u1ebft h\u1ee3p nhi\u1ec1u thu\u1ed1c n\u00ean c\u00e2n nh\u1eafc \u0111\u1ec3 nhanh ch\u00f3ng \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3.<\/p>\n

9.3.3. C\u00e1c thay \u0111\u1ed5i huy\u1ebft \u00e1p khi s\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft
\nC\u00e1c th\u1eed nghi\u1ec7m v\u1edbi nh\u00f3m thu\u1ed1c GLP-1 cho th\u1ea5y nh\u00f3m thu\u1ed1c n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng h\u1ea1 huy\u1ebft \u00e1p, m\u1ed9t ph\u1ea7n do t\u00e1c d\u1ee5ng gi\u1ea3m c\u00e2n c\u1ee7a n\u00f3. Gi\u1ea3m huy\u1ebft \u00e1p tr\u01b0\u1eddng k\u1ef3 c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y v\u1edbi thu\u1ed1c semaglutide (gi\u1ea3m HA t\u00e2m thu ph\u1ee5 thu\u1ed9c li\u1ec1u: \u22121.3 to
\n\u22122.6 mmHg) k\u00e8m t\u0103ng nh\u1eb9 nh\u1ecbp tim (+2 to 2.5 nh\u1ecbp\/ph\u00fat)<\/p>\n

V\u1edbi nh\u00f3m thu\u1ed1c SGLT-2, n\u00f3 l\u00e0m gi\u1ea3m huy\u1ebft \u00e1p m\u1ea1nh h\u01a1n khi so s\u00e1nh v\u1edbi GLP-1, v\u00e0 c\u00e1i hay l\u00e0 kh\u00f4ng l\u00e0m thay \u0111\u1ed5i nh\u1ecbp tim c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1ed9t ph\u00e2n t\u00edch t\u1eeb 7 nghi\u00ean c\u1ee9u RCT cho th\u1ea5y SGLT-2 gi\u1ea3m 3.6\/1.7 mmHg (t\u00e2m thu\/t\u00e2m tr\u01b0\u01a1ng) khi \u0111em so v\u1edbi hi\u1ec7u qu\u1ea3 c\u1ee7a hydrochlorothiazide li\u1ec1u th\u1ea5p.<\/p>\n

Recommendation Table 10 \u2014 Recommendations for blood pressure management in patients with diabetes<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Screening for hypertension<\/td>\n<\/tr>\n
\u0110o huy\u1ebft \u00e1p th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n
Treatment targets<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb thu\u1ed1c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi HA \u0111o t\u1ea1i ph\u00f2ng m\u1ea1ch
\n\u2265140\/90 mmHg, tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 d\u00e1i th\u00e1o \u0111\u01b0\u1eddng k\u00e8m theo<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb cao HA tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n ho\u00e1. M\u1ee5c ti\u00eau HA t\u00e2m thu l\u00e0 130 v\u00e0 <130mmHg n\u1ebfu dung n\u1ea1p, nh\u01b0ng kh\u00f4ng <120mmHg. V\u1edbi ng\u01b0\u1eddi gi\u00e0 (>65 tu\u1ed5i), khuy\u1ebfn c\u00e1o HA t\u00e2m thu 130-139 mmHg<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n
M\u1ee5c ti\u00eau HA t\u00e2m thu <130mmHg c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u0110 v\u1edbi c\u00e1c nguy c\u01a1 cao c\u1ee7a bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u n\u00e3o \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o<\/td>\nIIb<\/td>\nB<\/td>\n<\/tr>\n
Treatment and evaluation<\/td>\n<\/tr>\n
Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng (gi\u1ea3m c\u00e2n ,t\u1eadp th\u1ec3 d\u1ee5c, h\u1ea1n ch\u1ebf mu\u1ed1i…) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0110T\u0110 v\u00e0 t\u0103ng HA<\/td>\nI<\/td>\nA<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o n\u00ean kh\u1edfi tr\u1ecb v\u1edbi k\u1ebft h\u1ee3p thu\u1ed1c nh\u00f3m \u1ee9c ch\u1ebf renin
\n-angiotensin v\u1edbi m\u1ed9t \u1ee9c ch\u1ebf Canxi ho\u1eb7c m\u1ed9t l\u1ee3i ti\u1ec3u thiazide\/gi\u1ed1ng thiazide<\/td>\n		I<\/td>\n\u00a0A<\/td>\n<\/tr>\n
\n
\u0110o huy\u1ebft \u00e1p t\u1ea1i nh\u00e0 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110 k\u00e8m \u0111i\u1ec1u tr\u1ecb t\u0103ng HA<\/div>\n

 <\/td>\n

IIa<\/td>\nB<\/td>\n<\/tr>\n
\u0110o HA 24h n\u00ean xem x\u00e9t tr\u00ean c\u00e1c b\u1ea5t th\u01b0\u1eddng huy\u1ebft \u00e1p nh\u01b0 t\u0103ng huy\u1ebft \u00e1p v\u1ec1 \u0111\u00eam v\u00e0 gi\u1ea3m ho\u1eb7c thay \u0111\u1ed5i huy\u1ebft \u00e1p v\u1ec1 \u0111\u00eam \u0111\u1ec3 t\u1eeb \u0111\u00f3 \u0111\u01b0a ra \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/td>\nIIa<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

10. M\u1ee1 m\u00e1u v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

10.1.M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h3>\n

C\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng, LDL cao c\u00f9ng v\u1edbi HDL th\u1ea5p l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn c\u00e1c nguy c\u01a1 c\u0169ng nh\u01b0 t\u1eed vong tim m\u1ea1ch d\u00f9 b\u1ec7nh nh\u00e2n c\u00f3 hay kh\u00f4ng c\u00f3 b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c ngh\u00ean c\u1ee9u RCT, ch\u1ec9 ra r\u1eb1ng c\u1ee9 m\u1ed7i 1mmol gi\u1ea3m LDL l\u00e0 \u0111\u00e3 c\u00f3 th\u1ec3 gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch.<\/p>\n

Ch\u00ednh v\u00ec th\u1ebf, gi\u1ea3m LDL ch\u00ednh l\u00e0 m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u ti\u00ean ph\u00e1t c\u1ee7a c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb gi\u1ea3m m\u1ee1 m\u00e1u. M\u1ee5c ti\u00eau th\u1ee9 2, l\u00e0 ph\u1ea3i nh\u1eafm \u0111\u1ebfn t\u1ed1i \u01b0u ho\u00e1 c\u00e1c non-HDL c\u0169ng nh\u01b0 r\u1ed1i lo\u1ea1n triglyceride tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nh\u01b0ng ph\u00e1t bi
\n\u1ec3u n\u00e0y v\u1eabn c\u00f2n b\u1ecb gi\u1edbi h\u1ea1n v\u00ec c\u00f2n qu\u00e1 \u00edt nghi\u00ean c\u1ee9u. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb s\u1ebd thay \u0111\u1ed5i tu\u1ef3 v\u00e0o y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n ch\u1ee9 kh\u00f4ng ph\u1ea3i ai c\u0169ng nh\u01b0 ai. V\u00ec hi\u1ec7n nay b\u1eb1ng ch\u1ee9ng c\u00f2n \u00edt, n\u00ean kh\u00f4ng c\u00f3 khuy\u1ebfn c\u00e1o n\u00e0o r\u00f5 r\u00e0ng v\u1ec1 h\u1ea1 m\u1ee1 m\u00e1u cho c\u00e1c b\u1ec7nh nh\u00e2n k\u00e8m nguy c\u01a1 tim m\u1ea1ch nh\u01b0ng \u1edf m\u1ee9c th\u1ea5p.<\/p>\n

10.2. Statin<\/h3>\n

Statin v\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb gi\u1ea3m LDL tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110 v\u00e0 r\u1ed1i lo\u1ea1n m\u1ee1 m\u00e1u, do n\u00f3 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh ph\u00f2ng ng\u1eeba bi\u1ebfn c\u1ed1 c\u0169ng nh\u01b0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do tim m\u1ea1ch. Li\u1ec1u cao statin (rosuvastatin v\u00e0 atorvastatin) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u0110 c\u00f3 nguy c\u01a1 tim m\u1ea1ch \u1edf m\u1ee9c cao v\u00e0 r\u1ea5t cao, v\u00ec ch\u00fang c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m 40-63% m\u1ee9c LDL, v\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 m\u1ea1ch v\u00e0nh.
\nStatin nh\u00ecn chung l\u00e0 an to\u00e0n v\u00e0 d\u1ec5 s\u1eed d\u1ee5ng.<\/p>\n

10.3. Ezetimibe<\/h3>\n

C\u00f3 th\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 gi\u1ea3m LDL b\u1eb1ng c\u00e1ch th\u00eam ezetimibe v\u00e0o v\u1edbi statin, \u0111\u1ec3 gi\u1ea3m t\u00e1i h\u1ea5p thu m\u1ee1 t\u1eeb ru\u1ed9t non. Nghi\u00ean c\u1ee9u IMPROVE-IT (Improved Reduction
\nof Outcomes: Vytorin Efficacy International Trial) \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng hi\u1ec7u
\nqu\u1ea3 gi\u1ea3m MACE (k\u1ebft h\u1ee3p c\u00e1c nguy\u00ean nh\u00e2n t\u1eed vong tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim,
\n\u0111au th\u1eaft ng\u1ef1c c\u1ea7n nh\u1eadp vi\u1ec7n, t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh, ho\u1eb7c nh\u1ed3i m\u00e1u n\u00e3o kh\u00f4ng t\u1eed
\nvong, HR 0.94; 95% CI, 0.89\u20130.99) tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sau \u0111\u1ee3t h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p khi s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p simvastatin k\u00e8m ezetimibe, v\u00e0 nghi\u00ean c\u1ee9u c\u0169ng cho th\u1ea5y hi\u1ec7u qu\u1ea3 c\u00e0ng m\u1ea1nh h\u01a1n \u0111\u1ed1i v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (HR 0.85; 95% CI, 0.78\u20130.94; P <0.001). Ch\u00ednh v\u00ec l\u1ebd \u0111\u00f3, k\u1ebft h\u1ee3p ezetimibe v\u00e0 statin \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 b\u1ecb h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p m\u1edbi \u0111\u00e2y, nh\u1ea5t l\u00e0 c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng v\u1eabn kh\u00f4ng th\u1ec3 \u0111\u1ea1t LDL-C m\u1ee5c ti\u00eau l\u00e0 <1.4
\nmmol\/L (55 mg\/dL) v\u1edbi ch\u1ec9 d\u00f9ng statin \u0111\u01a1n \u0111\u1ed9c.<\/p>\n

10.4. Fibrate v\u00e0 c\u00e1c thu\u1ed1c h\u1ea1 TG kh\u00e1c<\/h3>\n

Vi\u1ec7c s\u1eed d\u1ee5ng fibrate \u0111\u1ec3 h\u1ea1 TG v\u1eabn c\u00f2n kh\u00e1 gi\u1edbi h\u1ea1n, do fibrate c\u00f3 nguy c\u01a1 g\u00e2y ra b\u1ec7nh l\u00fd c\u01a1 n\u1ebfu d\u00f9ng k\u00e8m statin v\u00e0 n\u00f3 \u00edt c\u00f3 l\u1ee3i \u00edch \u0111\u01b0\u1ee3c ch\u1ee9ng minh tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u RCT. Tr\u1eeb m\u1ed9t nh\u00f3m nh\u1ecf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c TG r\u1ea5t cao. Pemafibrate l\u00e0 1 thu\u1ed1c m\u1edbi \u0111\u01b0\u1ee3c ch\u1ee9ng minh v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi c\u00e1c fibrate truy\u1ec1n
\nth\u1ed1ng. Tuy nhi\u00ean c\u00f3 1 nghi\u00ean c\u1ee9u pha 3 v\u1ec1 pemafibrate \u0111\u00e3 ph\u1ea3i ng\u01b0ng s\u1edbm h\u01a1n
\nd\u1ef1 ki\u1ebfn v\u00ec ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng thu\u1ed1c kh\u00f4ng c\u00f3 \u00edch l\u1ee3i g\u00ec c\u1ea3. N\u1ebfu TG v\u1eabn t\u0103ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u tr\u1ecb c\u00f3 statin, icosapent ethyl l\u00e0 1 thu\u1ed1c m\u1ea1nh h\u01a1n omega-3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1ed5 sung v\u1edbi li\u1ec1u 2g\/ng\u00e0y. Do thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 th\u1ea5y c\u00f3 \u00edch l\u1ee3i nh\u1ea5t \u0111\u1ecbnh tr\u00ean tim m\u1ea1ch.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Lipid targets<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m nguy c\u01a1 tim m\u1ea1ch
\ntrung b\u00ecnh, khuy\u1ebfn c\u00e1o m\u1ee5c ti\u00eau LDL l\u00e0 <2.6
\nmmol\/L (<100 mg\/dL)<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m nguy c\u01a1 tim m\u1ea1ch
\ncao, khuy\u1ebfn c\u00e1o m\u1ee5c ti\u00eau LDL l\u00e0 <1.8 mmol\/L
\n(<70 mg\/dL) v\u00e0 gi\u1ea3m \u00edt nh\u1ea5t l\u00e0 50%<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102 k\u00e8m nguy c\u01a1 tim m\u1ea1ch
\nr\u1ea5t cao, khuy\u1ebfn c\u00e1o m\u1ee5c ti\u00eau LDL l\u00e0 <1.4 mmol\/L
\n(<55 mg\/dL) v\u00e0 gi\u1ea3m \u00edt nh\u1ea5t l\u00e0 50%<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102, m\u1ee5c ti\u00eau th\u1ee9 c\u1ea5p l\u00e0
\ngi\u1ea3m non-HDL <2.2 mmol\/L (<85 mg\/dL) tr\u00ean BN
\nnguy c\u01a1 tim m\u1ea1ch r\u1ea5t cao, v\u00e0 <2.6 mmol\/<2.6
\nmmol\/L (<100 mg\/dL)<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
Lipid-lowering treatment<\/td>\n<\/tr>\n
Statin l\u00e0 khuy\u1ebfn c\u00e1o \u0111\u1ea7u tay \u0111\u1ec3 h\u1ea1 LDL tr\u00ean
\nb\u1ec7nh nh\u00e2n \u0110T\u0110. C\u00e1ch cho statin d\u1ef1a tr\u00ean nguy
\nc\u01a1 tim m\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 LDL (non-HDL)
\nm\u1ee5c ti\u00eau mu\u1ed1n \u0111\u1ea1t.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Thu\u1ed1c PCSK9 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean c\u00e1c bn v\u1edbi
\nnguy c\u01a1 tim m\u1ea1ch r\u1ea5t cao, LDL t\u0103ng k\u00e9o d\u00e0i m\u1eb7c
\nd\u00f9 \u0111\u00e3 t\u1ed1i \u0111a li\u1ec1u statin dung n\u1ea1p \u0111\u01b0\u1ee3c, k\u00e8m v\u1edbi
\nk\u1ebft h\u1ee3p ezetimibe ho\u1eb7c tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n
\nkh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c statin<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
N\u1ebfu LDL m\u1ee5c ti\u00eau kh\u00f4ng \u0111\u1ea1t v\u1edbi statin, khuy\u1ebfn
\nc\u00e1o d\u00f9ng b\u1ed5 sung th\u00eam ezetimibe<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
N\u1ebfu kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng statin \u1edf b\u1ea5t c\u1ee9 li\u1ec1u s\u1eed
\nd\u1ee5ng n\u00e0o, \u1ee9c ch\u1ebf PCSK9 k\u00e8m ezetimibe l\u00fac n\u00e0y
\nn\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n
N\u1ebfu kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng statin \u1edf b\u1ea5t c\u1ee9 li\u1ec1u s\u1eed
\nd\u1ee5ng n\u00e0o, ezetimibe l\u00fac n\u00e0y n\u00ean c\u00e2n nh\u1eafc s\u1eed
\nd\u1ee5ng<\/td>\n		IIa<\/td>\nC<\/td>\n<\/tr>\n
Li\u1ec1u cao icosapent ethyl (2g \u2013 2l\/ng\u00e0y) c\u00f3 th\u1ec3
\nc\u00e2n nh\u1eafc k\u1ebft h\u1ee3p v\u1edbi statin tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n
\nt\u0103ng TG<\/td>\n		IIb<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

11. \u0110i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i v\u00e0 b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

11.1. B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh<\/h3>\n

tim m\u1ea1ch x\u01a1 v\u1eefa ho\u1eb7c t\u00e1i th\u00f4ng:
\nNghi\u00ean c\u1ee9u ph\u00e2n t\u00edch l\u1edbn nh\u1ea5t v\u1edbi 95000 ng\u01b0\u1eddi tham gia, trong \u0111\u00f3 c\u00f3 3818 b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (4%). Nghi\u00ean c\u1ee9u ch\u1ec9 ra ASA li\u1ec1u th\u1ea5p gi\u00fap gi\u1ea3m \u0111\u00e1ng k\u1ec3 MACE khi so v\u1edbi nh\u00f3m ch\u1ee9ng, k\u00e8m theo \u0111\u00f3 c\u0169ng t\u0103ng c\u00e1c bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft ngo\u00e0i s\u1ecd (0.10% vs.0.07%\/year; absolute risk increase 0.03%\/year; P < 0.0001)<\/p>\n\n\n\n\n
Recommendation<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102, kh\u00f4ng k\u00e8m b\u1ec7nh tim
\nm\u1ea1ch x\u01a1 v\u1eefa ho\u1eb7c t\u1eebng t\u00e1i th\u00f4ng, Aspirin (75-
\n100mg\/ ng\u00e0y) c\u00f3 th\u1ec3 xem x\u00e9t cho \u0111\u1ec3 ph\u00f2ng c\u00e1c bi\u1ebfn
\nc\u1ed1 m\u1ea1ch m\u00e1u n\u1eb7ng, n\u1ebfu nh\u01b0 kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9
\n\u0111\u1ecbnh.<\/td>\n		IIb<\/td>\nA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

11.2. B\u1ec7nh nh\u00e2n c\u00f3 c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch x\u01a1 v\u1eefa v\u00e0\/ho\u1eb7c t\u00e1i th\u00f4ng, v\u00e0 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng l\u00e2u d\u00e0i:<\/h3>\n

11.2.1.H\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh m\u1ea1n<\/p>\n

B\u1ec7nh nh\u00e2n \u0110T\u0110 k\u00e8m b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n ho\u1eb7c c\u00f3 t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc \u0111\u00f3, l\u00e0 c\u00e1c bn c\u00f3 nguy c\u01a1 tim m\u1ea1ch x\u1ebfp v\u00e0o lo\u1ea1i r\u1ea5t cao, v\u00e0 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y li\u1ec1u th\u1ea5p ASA (75-100mg\/ng\u00e0y) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng, m\u1eb7c d\u00f9 c\u00e1c
\nnghi\u00ean c\u1ee9u RCT cho khuy\u1ebfn c\u00e1o n\u00e0y c\u00f2n \u00edt.
\nClopidogrel l\u00e0 thu\u1ed1c c\u00f3 th\u1ec3 thay th\u1ebf ASA li\u1ec1u th\u1ea5p n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 u\u1ed1ng
\nASA, ho\u1eb7c c\u0169ng c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi ASA \u0111\u01b0\u1ee3c bi\u1ebft l\u00e0 li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh m\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da (PCI)<\/p>\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Khi c\u00e1c thu\u1ed1c kh\u00e1ng huy\u1ebft kh\u1ed1i \u0111\u01b0\u1ee3c ph\u1ed1i h\u1ee3p s\u1eed
\nd\u1ee5ng c\u00f9ng nhau, \u1ee9c ch\u1ebf b\u01a1m proton \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\ns\u1eed d\u1ee5ng \u0111\u1ec3 ng\u0103n ng\u1eeba xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y ru\u1ed9t<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Khi kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u ho\u1eb7c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c
\nd\u00f9ng, \u1ee9c ch\u1ebf b\u01a1m proton n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t d\u00f9ng \u0111\u1ec3
\nng\u0103n ng\u1eeba xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y ru\u1ed9t, nh\u01b0ng c\u00e2n nh\u1eafc
\nnguy c\u01a1 xu\u1ea5t huy\u1ebft tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n<\/td>\n		IIa<\/td>\nA<\/td>\n<\/tr>\n
Khi Clopidogrel \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, omeprazole v\u00e0
\nesomeprazole kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng \u0111\u1ec3 b\u1ea3o v\u1ec7
\nd\u1ea1 d\u00e0y<\/td>\n		III<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
ASA li\u1ec1u 75-100mg\/ng\u00e0y \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho bn
\n\u0110T\u0110 k\u00e8m NMCT ho\u1eb7c \u0111\u00e3 t\u1eebng t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean b\u1ec7nh nh\u00e2n ACS k\u00e8m \u0110T\u0110 \u0111\u00e3 PCI, P2Y12
\n(ticagrelor ho\u1eb7c prasugrel) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng
\nchung ASA (75-100mg\/ng\u00e0y), duy tr\u00ec h\u01a1n 12 th\u00e1ng.<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Clopidogrel 75mg, sau li\u1ec1u t\u1ea3i (600mg ho\u1eb7c \u00edt nh\u1ea5t 5
\nng\u00e0y li\u1ec1u duy tr\u00ec) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng chung
\nASA trong 6 th\u00e1ng sau khi stent m\u1ea1ch v\u00e0nh tr\u00ean bn
\nh\u1ed9i ch\u1ee9ng v\u00e0nh m\u1ea1n, n\u1ebfu nh\u01b0 kh\u00f4ng c\u00f3 nguy c\u01a1
\nxu\u1ea5t huy\u1ebft \u0111e do\u1ea1 t\u00ednh m\u1ea1ng<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Clopidogrel l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o thay th\u1ebf khi b\u1ec7nh nh\u00e2n
\nkh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c ASA<\/td>\n		I<\/td>\nB<\/td>\n<\/tr>\n
Tr\u00ean b\u1ec7nh nh\u00e2n ACS k\u00e8m \u0110T\u0110 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng
\nDAPT (kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p), \u0111ang b\u1eafc c\u1ea7u
\nm\u1ea1ch v\u00e0nh v\u00e0 kh\u00f4ng c\u1ea7n u\u1ed1ng kh\u00e1ng \u0111\u00f4ng l\u00e2u d\u00e0i,
\nkhuy\u1ebfn c\u00e1o ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng P12Y12 ngay sau ph\u1eabu
\nthu\u1eadt khi th\u1ea5y an to\u00e0n, v\u00e0 d\u00f9ng \u0111\u1ebfn 12 th\u00e1ng<\/td>\n		I<\/td>\nC<\/td>\n<\/tr>\n
Vi\u1ec7c m\u1edf r\u1ed9ng th\u1eddi gian d\u00f9ng DAPT l\u00ean h\u01a1n 12 th\u00e1ng
\ntr\u00ean bn ACS n\u00ean xem x\u00e9t d\u00f9ng l\u00ean \u0111\u1ebfn 3 n\u0103m tr\u00ean
\nc\u00e1c bn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng dung n\u1ea1p \u0111\u01b0\u1ee3c v\u1edbi DAPT n\u1ebfu
\nnh\u01b0 h\u1ecd kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft n\u1eb7ng.<\/td>\n		IIa<\/td>\nA<\/td>\n<\/tr>\n
B\u1ed5 sung th\u00eam rivaroxaban li\u1ec1u r\u1ea5t th\u1ea5p, k\u00e8m ASA
\nli\u1ec1u th\u1ea5p trong th\u1eddi gian l\u00e2u d\u00e0i \u0111\u1ec3 ph\u00f2ng c\u00e1c bi\u1ebfn
\nc\u1ed1 m\u1ea1ch m\u00e1u n\u00ean c\u00e2n nh\u1eafc tr\u00ean c\u00e1c bn \u0111\u00e1i th\u00e1o
\n\u0111\u01b0\u1eddng v\u00e0 CCS ho\u1eb7c PAD c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1ebfu nh\u01b0
\nkh\u00f4ng nguy c\u01a1 xu\u1ea5t huy\u1ebft cao.<\/td>\n		IIa<\/td>\nB<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n
Recommendations<\/td>\nClass<\/td>\nLevel<\/td>\n<\/tr>\n
Bn rung nh\u0129 v\u00e0 \u0111ang \u0111i\u1ec1u tr\u1ecb kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u
\nc\u1ea7u, c\u1ea7n d\u00f9ng kh\u00e1ng \u0111\u00f4ng, v\u00e0 kh\u00f4ng c\u00f3 CC\u0110,
\nNOAC \u0111\u01b0\u1ee3c \u01b0u ti\u00ean ch\u1ecdn h\u01a1n VKA<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean bn CCS ho\u1eb7c CCS k\u00e8m \u0110T\u0110 \u0111ang \u0111\u1eb7t stent
\nm\u1ea1ch v\u00e0nh v\u00e0 c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng \u0111\u00f4ng, \u0111i\u1ec1u tr\u1ecb 3
\nthu\u1ed1c: li\u1ec1u th\u1ea5p ASA + clopodogrel + kh\u00e1ng \u0111\u00f4ng
\nu\u1ed1ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng \u00edt nh\u1ea5t 1 tu\u1ea7n, sau
\n\u0111\u00f3 chuy\u1ec3n sang li\u1ec7u tr\u00ecnh k\u00e9p: kh\u00e1ng \u0111\u00f4ng u\u1ed1ng +
\n1 thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/td>\n		I<\/td>\nA<\/td>\n<\/tr>\n
Tr\u00ean bn CCS ho\u1eb7c CCS k\u00e8m \u0110T\u0110 \u0111ang \u0111\u1eb7t stent
\nm\u1ea1ch v\u00e0nh v\u00e0 c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng \u0111\u00f4ng, \u0111i\u1ec1u tr\u1ecb k\u00e9o
\nd\u00e0i 3 thu\u1ed1c: li\u1ec1u th\u1ea5p ASA + clopodogrel + kh\u00e1ng
\n\u0111\u00f4ng u\u1ed1ng n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u00f9ng l\u00ean \u0111\u1ebfn 1
\nth\u00e1ng n\u1ebfu l\u1ee3i \u00edch v\u01b0\u1ee3t nguy c\u01a1 xu\u1ea5t huy\u1ebft tr\u00ean
\nt\u1eebng bn<\/td>\n		IIa<\/td>\nC<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

 <\/p>\n

\"ESC<\/a>
B\u1ea3ng: Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p ho\u1eb7c m\u1ea1n t\u00ednh \u0111\u00e3 ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh ho\u1eb7c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da v\u00e0 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ec9nh d\u00f9ng kh\u00e1ng \u0111\u00f4ng u\u1ed1ng l\u00e2u d\u00e0i.<\/figcaption><\/figure>\n

12. B\u1ec7nh m\u1ea1ch v\u00e0nh v\u00e0 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

12.1. H\u1ed9i ch\u1ee9ng v\u00e0nh m\u1ea1n v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h3>\n

12.1.1.Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng
\n\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 cho b\u1ec7nh tim thi\u1ebfu m\u00e1u v\u00e0 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (CAD). C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00ean b\u1ec7nh nh\u00e2n k\u00e8m \u0110T\u0110 th\u01b0\u1eddng \u00edt r\u1ea7m r\u1ed9 v\u00e0 kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.
\n12.1.2.T\u1ea7m so\u00e1t v\u00e0 ch\u1ea9n \u0111o\u00e1n
\nCh\u00fang t\u1ed1i \u01b0u ti\u00ean theo h\u01b0\u1edbng d\u1eabn c\u1ee7a ESC 2019. Chi\u1ebfn l\u01b0\u1ee3c t\u1ea7m s\u00e1ot v\u1eabn c\u00f2n nhi\u00eau tranh c\u1ea3i. Nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y t\u1ea7m so\u00e1t b\u1ec7nh m\u1ea1ch v\u00e0nh tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f4ng tri\u1ec7u ch\u1ee9ng v\u00e0nh ch\u1eb3ng kh\u00e1c bi\u1ec7t g\u00ec v\u1ec1 k\u1ebft qu\u1ea3 v\u1edbi
\nc\u00e1c khuy\u1ebfn c\u00e1o chu\u1ea9n.
\n12.1.3.\u0110i\u1ec1u tr\u1ecb
\n\u0110i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n \u0110TD k\u00e8m b\u1ec7nh m\u1ea1ch v\u00e0nh ch\u1ee7 y\u1ebfu l\u00e0 thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, ch\u1ec9nh huy\u1ebft \u00e1p, ch\u1ec9nh m\u1ee1 m\u00e1u, b\u00e9o ph\u00ec. M\u1ee5c ti\u00eau khi s\u1eed d\u1ee5ng thu\u1ed1c l\u00e0 l\u00e0m gi\u1ea3m nguy c\u01a1 x\u1ea3y ra c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch
\n12.1.3.1. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb
\n12.1.3.1.1. Thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng:
\nD\u1ef1a tr\u00ean nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra SGLT2 inhibitors v\u00e0\/ho\u1eb7c GLP-1 Ras l\u00e0 c\u00e1c
\nthu\u1ed1c c\u00f3 th\u1ec3 gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00e0 n\u00ean \u0111\u01b0\u1ee3c cho tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3
\nb\u1ec7nh m\u1ea1ch v\u00e0nh.<\/p>\n

12.1.3.1.2. C\u00e1c thu\u1ed1c kh\u00e1c: Do b\u1ea3n ch\u1ea5t an lan c\u1ee7a b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, nhi\u1ec1u
\nb\u1ec7nh nh\u00e2n \u0110T\u0110 s\u1ebd kh\u00f4ng th\u1ec3 t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh. Vi\u1ec7c gi\u1ea3m tri\u1ec7u ch\u1ee9ng cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch t\u0103ng c\u01b0\u1eddng cung c\u1ea5p oxy cho c\u01a1 tim b\u1eb1ng nitrate t\u00e1c d\u1ee5ng d\u00e0i ho\u1eb7c thu\u1ed1c nh\u00f3m CCB ho\u1eb7c c\u00f3 th\u1ec3 b\u1eb1ng gi\u1ea3m nhu c\u1ea7u c\u01a1 tim b\u1eb1ng c\u00e1c thu\u1ed1c nh\u01b0: \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 beta, non-dihydropyridine
\nCCBs, ranolazine, ho\u1eb7c ivabradine.<\/p>\n

13. Suy tim v\u00e0 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h2>\n

13.1. \u0110\u1ecbnh ngh\u0129a v\u00e0 sinh l\u00fd b\u1ec7nh<\/h3>\n

Suy tim kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t b\u1ec7nh v\u1edbi m\u1ed9t c\u01a1 ch\u1ebf b\u1ec7nh h\u1ecdc \u0111\u01a1n l\u1ebb, m\u00e0 n\u00f3 l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u ho\u1eb7c tri\u1ec7u ch\u1ee9ng \u0111\u00e3 c\u00f3 ho\u1eb7c \u0111ang c\u00f3 g\u00e2y ra c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u1ea5u tr\u00fac ho\u1eb7c ch\u1ee9c n\u0103ng cho tim. N\u00f3 \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n b\u1eb1ng vi\u1ec7c t\u0103ng natri-uretic peptide, v\u00e0\/ho\u1eb7c c\u00e1c b\u1ec7nh l\u00fd ph\u1ed5i do tim m\u1ea1ch ho\u1eb7c sung huy\u1ebft to\u00e0n th\u00e2n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng c\u00e1c h\u00ecnh th\u00e1i x\u00e9t nghi\u1ec7m kh\u00e1c nh\u01b0 h\u00ecnh \u1ea3nh
\nh\u1ecdc ho\u1eb7c \u0111o l\u01b0\u1eddng huy\u1ebft \u0111\u1ed9ng x\u00e2m l\u1ea5n. Suy tim l\u00e0 m\u1ed9t trong c\u00e1c h\u00ecnh th\u00e1i ban \u0111\u1ea7u ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a b\u1ec7nh l\u00fd tim m\u1ea1ch tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0110T\u01102, v\u00e0 c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m, gi\u1ea3m nh\u1eb9 ho\u1eb7c b\u1ea3o t\u1ed3n.<\/p>\n

Nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a suy tim tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u0110 l\u00e0 b\u1ec7nh tim thi\u1ebfu m\u00e1u, t\u0103ng huy\u1ebft \u00e1p, t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, b\u00e9o ph\u00ec c\u0169ng nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u01a1 tim. B\u1ec7nh tim thi\u1ebfu m\u00e1u l\u00e0 lo\u1ea1i b\u1ec7nh v\u1edbi \u0111\u1eb7c tr\u01b0ng, lan to\u1ea3, n\u1eb7ng, ti\u1ebfn tri\u1ec3n nhanh v\u00e0 \u0111\u00e1ng s\u1ee3 l\u00e0 n\u00f3 di\u1ec5n ra th\u1ea7m l\u1eb7ng, n\u00f3 l\u00e0m t\u0103ng nguy c\u01a1 x\u1ea9y ra nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 tim do thi\u1ebfu m\u00e1u. C\u00e1c d\u1eef li\u1ec7u t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t \u0111\u00e3 ch\u1ec9 ra, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi, th\u1eddi gian m\u1eafc \u0110T\u0110, tu\u1ed5i t\u00e1c, t\u0103ng BMI c\u0169ng nh\u01b0 b\u1ec7nh th\u1eadn m\u1ea1n \u0111\u1ec1u c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c g\u00e2y ra suy tim tr\u00ean b\u1ec7nh nh\u00e2n \u0110T\u0110.<\/p>\n

Trong nhi\u1ec1u th\u1eadp k\u1ef7, kh\u00e1i ni\u1ec7m \u201cb\u1ec7nh c\u01a1 tim do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng\u201d \u0111\u00e3 \u0111\u01b0\u1ee3c mang ra th\u1ea3o lu\u1eadn, v\u1edbi nh\u1eefng nghi\u00ean c\u1ee9u quan s\u00e1t nh\u1ecf, v\u00e0 \u00fd ki\u1ebfn c\u00e1c chuy\u00ean gia ng\u00e0y c\u00e0ng kh\u1eb3ng \u0111\u1ecbnh cho s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a n\u00f3, tuy nhi\u00ean c\u1ea7n nhi\u1ec1u b\u1eb1ng ch\u1ee9ng
\nh\u01a1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh vi\u1ec7c n\u00e0y.<\/p>\n

13.2. D\u1ecbch t\u1ec5 v\u00e0 ti\u00ean l\u01b0\u1ee3ng<\/h3>\n

\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a suy tim. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra n\u00f3 g\u00e2y t\u0103ng nguy c\u01a1 m\u1eafc suy tim g\u1ea5p 2-4 l\u1ea7n so v\u1edbi ng\u01b0\u1eddi kh\u00f4ng c\u00f3 \u0110T\u0110. T\u1ea7n su\u1ea5t suy tim t\u0103ng tuy\u1ebfn t\u00ednh v\u1edbi tu\u1ed5i t\u00e1c tr\u00ean c\u1ea3 ng\u01b0\u1eddi c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 \u0110T\u0110.
\nC\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0110T\u0110 th\u01b0\u1eddng t\u0103ng t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n \u1edf l\u1ee9a tu\u1ed5i tr\u1ebb h\u01a1n
\nnhi\u1ec1u so v\u1edbi ng\u01b0\u1eddi kh\u00f4ng \u0110T\u0110, nghi\u00ean c\u1ee9u ch\u1ec9 ra t\u1ef7 l\u1ec7 n\u00e0y l\u00e0 11.0 (95% CI, 5.6\u201321.8) v\u1edbi bn <45 tu\u1ed5i. M\u1ed9t nghi\u00ean c\u1ee9u l\u1edbn \u0111\u00e3 t\u00ecm th\u1ea5y 36% b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa suy tim \u1ed5n \u0111\u1ecbnh b\u1ecb m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng k\u00e8m theo, v\u00e0 con s\u1ed1 n\u00e0y l\u00e0 50% tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 suy tim c\u1ea5p ph\u1ea3i nh\u1eadp vi\u1ec7n. V\u00e0 nghi\u00ean c\u1ee9u c\u0169ng ch\u1ec9
\nra, c\u00e1c t\u1eed vong tim m\u1ea1ch c\u0169ng cao h\u01a1n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 k\u00e8m b\u1ec7nh \u0111\u00e1i th\u00e1o
\n\u0111\u01b0\u1eddng.<\/p>\n

13.3. T\u1ea7m so\u00e1t v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h3>\n

B\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng s\u1ebd t\u0103ng nguy c\u01a1 suy tim nh\u01b0ng kh\u00f4ng ph\u1ea3i t\u1ea5t
\nc\u1ea3 \u0110T\u0110 s\u1ebd b\u1ecb suy tim. Ch\u00ednh v\u00ec th\u1ebf, t\u1ea7m so\u00e1t s\u1edbm suy tim tren b\u1ec7nh nh\u00e2n \u0110T\u0110
\ns\u1ebd gi\u00fap s\u1edbm ph\u00e1t hi\u1ec7n v\u00e0 ng\u0103n ch\u1eb7n. \u0110\u1ec3 ti\u00ean l\u01b0\u1ee3ng nguy c\u01a1 suy tim tr\u00ean c\u00e1c
\nb\u1ec7nh nh\u00e2n \u0110T\u0110 ngo\u1ea1i tr\u00fa, thang \u0111i\u1ec3m WATCH-DM (c\u00e2n n\u1eb7ng [BMI], tu\u1ed5i, cao huy\u1ebft \u00e1p, Creatinine, HDL-C, t\u00ecnh tr\u1ea1ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft [\u0111\u01b0\u1eddng \u0111\u00f3i], th\u1eddi gian QRS, nh\u1ed3i m\u00e1u c\u01a1 tim, v\u00e0 b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh) \u0111\u00e3 ra \u0111\u1eddi. M\u1ed5i 1 \u0111i\u1ec3m t\u0103ng trong thang \u0111i\u1ec3m s\u1ebd t\u0103ng 24% nguy c\u01a1 suy tim trong 5 n\u0103m t\u1edbi. B\u1ed5 sung th\u00eam, \u0111i\u1ec3m nguy c\u01a1 d\u1ef1a tr\u00ean c\u00e1c x\u00e9t nghi\u1ec7m bao g\u1ed3m troponin si\u00eau nh\u1ea1y T \u22656 ng\/L, NT-proBNP \u2265125 pg\/mL, Crp si\u00eau nh\u1ea1y \u22653 mg\/L, v\u00e0 ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i tr\u00ean ecg. Nguy c\u01a1 kh\u1ea3 n\u0103ng cao nh\u1ea5t s\u1ebd x\u1ea3y ra suy tim cho c\u00e1c b\u1ec7nh nh\u00e2n \u22653 \u0111i\u1ec3m.<\/p>\n

\u0110\u1ec3 ph\u00e1t hi\u1ec7n suy tim, th\u01b0\u1eddng xuy\u00ean ch\u00fa \u00fd c\u00e1c d\u1ea5u hi\u1ec7u: c\u01a1 n\u0103ng (kh\u00f3 th\u1edf, kh\u00f3
\nth\u1edf khi g\u1eafng s\u1ee9c, kh\u00f3 th\u1edf v\u1ec1 \u0111\u00eam tho\u00e1ng qua, m\u1ea5t ng\u1ee7, m\u1ec7t m\u1ecfi, t\u0103ng th\u1eddi
\ngian ngh\u1ec9 sau g\u1eafng s\u1ee9c), th\u1ef1c th\u1ec3 (t\u0103ng c\u00e2n, ph\u00f9 ngo\u1ea1i bi\u00ean, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i,
\nti\u1ebfng tim th\u1ee9 3…) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o n\u00ean ch\u00fa \u00fd.
\nCh\u1ec9 c\u1ea7n m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u tr\u00ean xu\u1ea5t hi\u1ec7n, th\u00ec n\u00ean nghi ng\u1edd suy tim v\u00e0 l\u00e0m
\nth\u00eam c\u00e1c c\u1eadn l\u00e2m s\u00e0ng: X\u00e9t nghi\u1ec7m natriuretic peptides \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o n\u1ebfu c\u00f3 s\u1eb5n, gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng \u00e2m n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t:<\/p>\n

WATCH-DM (c\u00e2n n\u1eb7ng [BMI], tu\u1ed5i, cao huy\u1ebft \u00e1p, Creatinine, HDL-C, t\u00ecnh
\ntr\u1ea1ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft<\/p>\n

B-type natriuretic peptide (BNP) <35 pg\/mL (trong rung nh\u0129 : <105 pg\/mL).
\nNT-proBNP <125 pg\/mL (trong rung nh\u0129 : <365 pg\/mL).
\nTuy nhi\u00ean natri-uretic peptide c\u00f3 th\u1ec3 gi\u1ea3m tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec, ho\u1eb7c
\ntr\u00ean ph\u1ee5 n\u1eef. V\u00e0 cao gi\u1ea3 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, b\u1ec7nh th\u1eadn m\u1ea1n, rung nh\u0129.
\nNh\u01b0ng khi BNP \u0111\u00e3 t\u0103ng th\u00ec n\u00f3 c\u0169ng l\u00e0 c\u00f4ng c\u1ee5 g\u1ee3i \u00fd kh\u1ea3 n\u0103ng suy tim v\u00e0 l\u00fac n\u00e0y n\u00ean l\u00e0m th\u00eam c\u00e1c c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c:<\/p>\n