If the patient has known cardiovascular disease or if the patient is > 40 years old with multiple risk factors for cardiovascular disease, then the patient should be treated with:
(1) a statin (if not contraindicated)
(2) aspirin (if not contraindicated)
(3) an ACE inhibitor (if not contraindicated)
If the patient has an elevated blood pressure, then this should be treated.
If the patient has a history of congestive heart failure, then the following oral agents are contraindicated:
(1) metformin
(2) thiazolidinedione (due to fluid retention)
If the patient has a history of myocardial infarction, then beta-blocker therapy should be considered. A specific beta-1 antagonist is recommended since there it is less likely to mask hypoglycemia or cause hyperkalemia.
The patient should undergo additional testing (exercise testing, angiography, etc) if:
(1) the patient has typical or atypical cardiac symptoms
(2) the patient has an abnormal ECG
