The Journal of the American College of Cardiology has published an expert consensus decision pathway (ECDP) on novel therapies for CV risk reduction in patients with T2DM [1].
Over the past years, several studies have shown that SGLT2i and GLP-1RAs reduce the risk of major adverse CV events (MACE). SGLT2i also reduce the risk of HF hospitalization and progression of diabetic kidney disease (DKD) [2-9]. The mechanisms of CV and renal benefits with these compounds remains uncertain, but appear to exceed their direct glucose-lowering effects [10,11]. Since CVD remains the leading cause of morbidity and mortality in T2DM, awareness of clinical evidence regarding CV benefits of SGLT2i and GLP1RAs is of importance to CV specialists. This ECDP provides guidance on initiation and monitoring of SGLT2i or GLP-1RAs with proven CV benefit in T2DM patients with ASCVD, HF, DKD or at high risk for ASCVD, with the goal of reducing CV risk.
1. Das SR, Everett BM, Birtcher KK et al., 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee J Am Coll Cardiol. 2020 Sep 1;76(9):1117-1145.
2. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117–28.
3. Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375:323–34.
4. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–22.
5. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–44.
6. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644–57.
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8. Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomized placebo-controlled trial. Lancet. 2019;394:121–30.
9. Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295–306.
10. Inzucchi SE, Zinman B, Fitchett D, et al. How does empagliflozin reduce cardiovascular mortality? insights from a medication analysis of the EMPA-REG OUTCOME trial. Diabetes Care. 2018;41:356–63.
11. Li J, Woodward M, Perkovic V, et al. Mediators of the effects of canagliflozin on heart failure in patients with type 2 diabetes. J Am Coll Cardiol HF. 2020;8:57–66.
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