ACC Expert Consensus: antihyperglycemic agents for ASCVD in T2D

  • J Am Coll Cardiol

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • With type 2 diabetes (T2D) and high risk for or established atherosclerotic cardiovascular (CV) disease (ASCVD), this American College of Cardiology (ACC) expert consensus publication offers decision pathways for using newer antihyperglycemic agents with ASCVD risk reduction potential.
  • The 2 classes of T2D agents are sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs).

Why this matters

  • Both drug classes are tied to reduced major adverse cardiac event (MACE) rates, independent of glucose-lowering effects.
  • Cardiologists can now get more involved in T2D treatment pathways.

Key points

  • CV specialists can address 3 major areas for patients with T2D:
    • Screening those at high ASCVD risk.
    • Aggressively treating ASCVD risk factors.
    • Using these newer agents in routine practice.
    • Patients with T2D can choose agents that reduce blood glucose and ASCVD risk.
    • SGLT2is empagliflozin (Jardiance) and canagliflozin (e.g., Invokana) reduce MACE, heart failure (HF) hospitalization; empagliflozin also reduces CV, all-cause mortality risks.
    • GLP-1RA liraglutide (e.g., Saxenda) reduces MACE risk.
  • Choice depends on patient factors:
    • SGLT2i better, e.g., with HF.
    • GLP-1RA better, e.g., with osteoporosis, neuropathy, ulcers.
    • Can be used together if indicated.
  • Considerations with SGLT2is include:
    • Avoid hypovolemia (e.g., reduce thiazide dose).
    • Advise patient regarding low BP, diabetic ketoacidosis symptoms, foot care/pulse exams, genital mycotic infections.
  • Considerations with GLP-1RAs include:
    • Start at lowest dose, slow up-titration.
    • Monitor for diabetic retinopathy.

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