Mini Focus on Diabetes
The Present and Future
JACC State-of-the-Art Review
The Changing Landscape of Diabetes Therapy for Cardiovascular Risk Reduction: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2018.07.071Get rights and content
Under an Elsevier user license
open archive

Abstract

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.

Key Words

antidiabetic therapy
cardiovascular disease
primary prevention
secondary prevention
type 2 diabetes

Abbreviations and Acronyms

CVD
cardiovascular disease
GLP-1 RA
glucagon-like peptide-1 receptor agonists
HbA1c
glycated hemoglobin
HR
hazard ratio
LDL
low-density lipoprotein
MI
myocardial infarction
SGLT2-i
sodium-glucose cotransporter-2 inhibitors
T2D
type 2 diabetes mellitus

Cited by (0)

Drs. Newman and Berger have been partially funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health (K23HL125991 to Dr. Newman; HL114978 to Dr. Berger). Dr. Aleman has been partially funded by the American Heart Association. Funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the paper. Dr. Weintraub has received honoraria from Amgen, Sanofi, and Gilead for consulting; has served on the Speakers Bureau for Amgen; and has received research funding from Amarin, Sanofi, Akcea, and Ionis. Dr. Berger has received research funding from AstraZeneca and Janssen. Dr. Schwartzbard has received research funding to New York University from Merck/Pfizer, Amarin, Sanofi, and Ionis; and has served as a consultant to the formulary committee for Optum Rx. Dr. Vani has reported that he has no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.