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

• Published in: Journal of the American College of Cardiology Vol. 72; no. 15; pp. 1856 - 1869
• Main Authors: Newman, Jonathan D, Vani, Anish K, Aleman, Jose O, Weintraub, Howard S, Berger, Jeffrey S, Schwartzbard, Arthur Z
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 09-10-2018
• 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; Glucagon; Glucagon-like peptide 1; Glucose; Health risks; Heart diseases; Heart failure; Humans; Hypoglycemia; Hypoglycemic Agents - pharmacology; Infections; Inhibitors; Metabolic syndrome; Mortality; Na+/glucose cotransporter; Patients; Renal failure; Renal function; Risk analysis; Risk Factors; Risk management; Secondary Prevention - methods; Sodium; Stroke; primary prevention; cardiovascular disease; secondary prevention; type 2 diabetes; antidiabetic therapy
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.07.071

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.