The Changing Landscape of Diabetes Therapy for Cardiovascular Risk Reduction: JACC State-of-the-Art Review

Type 2 diabetes mellitus (T2D) is a major risk factor for cardiovascular disease (CVD), the most common cause of death in T2D. Despite improved risk factor control, however, adults with T2D continue to experience substantial excess CVD risk. Until recently, however, improved glycemic control has not...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2018-10, Vol.72 (15), p.1856-1869
Main Authors: Newman, Jonathan D, Vani, Anish K, Aleman, Jose O, Weintraub, Howard S, Berger, Jeffrey S, Schwartzbard, Arthur Z
Format: Article
Language:English
Subjects:
Adults
Antidiabetics
Blood pressure
Cardiology
Cardiovascular diseases
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - prevention & control
Clinical trials
Diabetes
Diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 2 - epidemiology
Diabetes Mellitus, Type 2 - therapy
Disease prevention
GLP-1 receptor agonists
Glucagon
Glucagon-like peptide 1
Glucose
Health risks
Heart diseases
Heart failure
Humans
Hypoglycemia
Hypoglycemic Agents - pharmacology
Infections
Inhibitors
Metabolic syndrome
Mortality
Patients
Renal failure
Renal function
Risk analysis
Risk Factors
Risk management
Secondary Prevention - methods
Sodium
Sodium-glucose cotransporter
Stroke
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Summary:Type 2 diabetes mellitus (T2D) is a major risk factor for cardiovascular disease (CVD), the most common cause of death in T2D. Despite improved risk factor control, however, adults with T2D continue to experience substantial excess CVD risk. Until recently, however, improved glycemic control has not been associated with robust macrovascular benefit. The advent of 2 new classes of antihyperglycemic agents, the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, and their respective large cardiovascular outcome trials, has led to a paradigm shift in how cardiologists and heath care practitioners conceptualize T2D treatment. Herein, the authors review the recent trial evidence, the potential mechanisms of action of the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, safety concerns, and their use for the primary prevention of CVD as well as in diabetic patients with impaired renal function and heart failure.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2018.07.071