The American Heart Association (AHA) has issued a new Scientific Statement in Circulation which updates the clinical management of coronary artery disease (CAD) in patients with type 2 diabetes (T2DM). The AHA states that strict glycaemic control may not be as important as how exactly this control is achieved for patients with T2DM and CAD. T2DM has the potential to affect a number of treatment choices for CAD.
- Metformin, the most popular initial glucose-lowering treatment, sometimes produces mild weight loss, is neutral regarding the cardiovascular effect, inexpensive and has a long safety record.
- Sodium-glucose co-transporter inhibitors are the first class of drugs that not only lower glycaemia but also improve cardiovascular, renal and weight outcomes.
- Glucagon-like peptide-1 receptor agonists also lower blood glucose and reduce weight and could also diminish hypercholesterolaemia-related cardiovascular disease.
- Aspirin may be appropriate in CAD but is less effective in patients with T2D and CAD, so other antiplatelet drugs may have to be considered.
- Patients with CAD and T2D do better when they undergo a coronary artery bypass graft than when they undergo angioplasty and stenting.
Other comorbidities important to control in patients with T2D are hypertension and hypercholesterolaemia (statins, cholesterol absorption inhibitors).