2020 Novel Therapies for CV Risk Reduction in Diabetes Decision Pathway

Authors:
Das SR, Everett BM, Birtcher KK, et al.
Citation:
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;Aug 5:[Epub ahead of print].

The following are key points to remember from a report of the American College of Cardiology Solution Set Oversight Committee on novel therapies for cardiovascular (CV) risk reduction in patients with type 2 diabetes (T2D):

  1. CV disease remains the leading cause of morbidity and mortality in patients with T2D.
  2. The development of treatment strategies to improve CV outcomes in patients with T2D remains a major priority.
  3. The recent development of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) has for the first time, demonstrated that specific glucose-lowering therapies can directly improve CV outcomes.
  4. This Expert Consensus Decision Pathway provides a practical guide to CV specialists for the initiation and monitoring of SGLT2 inhibitors and GLP-1RAs with the express goal of reducing CV risk.
  5. This Expert Consensus Decision Pathway recommends initiating a patient-clinician discussion about the use of an SGLT2 inhibitor and/or a GLP-1RA with demonstrated CV benefit at the time of a clinical follow-up visit for patients with T2D who have or who are at very high risk for clinical atherosclerotic CV disease (ASCVD), heart failure (HF), and/or diabetic kidney disease (DKD).
  6. An SGLT2 inhibitor with demonstrated CV benefit is recommended for patients with T2D and HF, especially HF with reduced ejection fraction (HFrEF), or who are at high risk of developing HF, DKD, clinically evident ASCVD, or any combination of these conditions. A GLP-1RA with demonstrated CV benefit is recommended for patients with established or at very high risk for ASCVD.
  7. It appears reasonable to use both an SGLT2 inhibitor and a GLP-1RA, with demonstrated CV benefit, concomitantly if clinically indicated, even though such combination therapy has not been studied for CV risk reduction.
  8. These treatment algorithms should be used in concert with established risk factor modification guidelines for the prevention of major adverse cardiac events in patients with T2D, including guidelines on lipids, blood pressure, and antiplatelet therapy.
  9. The main goals of care for patients with T2D are to improve survival and quality of life.
  10. Given the data supporting comprehensive CV risk reduction in patients with T2D, CV clinicians need to be both champions and change agents as strong advocates for our patients, recognizing unmet needs in health care delivery, and extending their comfort zone in implementing the use of new evidence-based therapies that reduce CV event rates.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Acute Heart Failure

Keywords: Atherosclerosis, Blood Glucose, Blood Pressure, Delivery of Health Care, Delivery of Health Care, Integrated, Diabetes Mellitus, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Drug Therapy, Glucagon-Like Peptide 1, Glucose, Heart Failure, Kidney Diseases, Lipids, Metabolic Syndrome X, Patient Care Team, Platelet Aggregation Inhibitors, Primary Prevention, Quality of Life, Renal Insufficiency, Risk Factors, Risk Reduction Behavior, Safety, Secondary Prevention, Sodium-Glucose Transporter 2


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