2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

Das, Sandeep R; Everett, Brendan M.; Birtcher, Kim K.; Brown, Jenifer M; Januzzi, James L.; Kalyani, Rita R.; Kosiborod, Mikhail; Magwire, Melissa; Morris, Pamela B.; Neumiller, Joshua J.; Sperling, Laurence

doi:10.1016/j.jacc.2020.05.037

Cited by 323 publications

(308 citation statements)

References 91 publications

Supporting

Mentioning

295

Contrasting

Unclassified

Order By: Relevance

“…The ability of risk scores to identify patients who may derive the largest absolute benefit from SGLT2 inhibitors is clinically important in order to target these therapies appropriately. Currently, clinical practice guidelines and regulatory labelling focus on individuals with preexisting (or at high risk of developing) atherosclerotic CV disease with regard to who may benefit from SGLT2 inhibitor treatment 4,17–19 . Our results suggest that, because additional clinical risk factors beyond atherosclerotic CV disease many identify individuals with T2DM at high risk of HF outcomes, a broader population of people with T2DM may warrant and could benefit from therapies such as SGLT2 inhibitors; however, this will require further validation in adequately powered randomized trials.…”

Section: Discussionmentioning

confidence: 87%

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HF_DM) in patients in the ACCORD trial

Elharram

Ferreira

Huynh

et al. 2021

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aim To investigate the ability of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HFDM) to stratify patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risk for heart failure (HF) hospitalization. Materials and Methods We used data from the control group of the Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD) trial (n = 5123; mean follow‐up 4.8 years). The TRS‐HFDM includes: prior HF (2 points), atrial fibrillation (1 point), coronary artery disease (1 point), estimated glomerular filtration rate <60 mL/min/1.73 m2 (1 point), and urine albumin‐to‐creatinine ratio (>300 mg/g: 2 points; 30–300 mg/g: 1 point). We evaluated the discrimination (Harrell's C‐index) and calibration (Nam‐D'Agostino calibration statistic) of the TRS‐HFDM with regard to time to HF hospitalization or death due to HF. Results The mean age of the participants was 62.8 ± 6.6 years, and 38% were women. The prevalences of TRS‐HFDM 0, 1, 2, 3 and ≥4 were 42.1%, 34.9%, 14.6%, 6.0% and 2.5%, respectively. Increasing TRS‐HFDM corresponded to an increasing HF risk: 1.3 per 1000 person‐years for a TRS‐HFDM of 0 to 64.7 per 1000 person‐years for TRS‐HFDM of ≥4. The TRS‐HFDM demonstrated robust discrimination of HF outcomes (C‐index 0.78). Furthermore, the score was well calibrated for HF outcomes (calibration statistic P = 0.13). Similar results were seen in participants without baseline HF (C‐index 0.75). Conclusion The TRS‐HFDM discriminates HF‐specific risk among people with T2DM. The use of TRS‐HFDM to identify those who would maximally benefit from therapies that reduce HF risk warrants evaluation.

show abstract

Section: Discussionmentioning

confidence: 87%

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HF_DM) in patients in the ACCORD trial

Elharram

Ferreira

Huynh

et al. 2021

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…These results are of clinical signi cance, because Type 2 diabetes mellitus (T2DM) is a major risk factor affecting coronary artery disease (CAD), despite signi cant advances in the treatment of cardiovascular disease over the past 20 years, cardiovascular disease remains the leading cause of morbidity and mortality in patients with Type 2 diabetes mellitus, 75% of T2DM patients die as a consequence of cardiovascular diseases. (22,23) With the improvement of PCI-related technology and equipment, PCI indications have become more extensive and complex, and the amount of surgery has increased year by year. (24) Patients who develop CIN have a greater risk for a number of non-renal complications including cardiac, vascular and systemic problems.…”

Section: Discussionmentioning

confidence: 99%

Glycosylated Hemoglobin levels and the Risk for Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary arteriography/Percutaneous Coronary Intervention

Zhang

et al. 2021

Preprint

View full text Add to dashboard Cite

Backgrounds: Diabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to evaluate whether preoperative hemoglobin a1c levels in diabetic patients who received CAG/PCI had an impact on the occurrence of postoperative CIN.Methods: We reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020, and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48h and 72h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Multivariable logistic regression analysis was used to exclude the influence of confounding factors and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN. Results: Patients with elevated HbA1c had higher BMI, FBG and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 24h and 48h Scr. (Table 1) The incidence of CIN in the 5 groups of patients were: 9.8%, 11.9%, 15.2%, 25.3%, 48.1%. (p<0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. (Figure 2) Trend test showed the change of HR (1.000,1.248,1.553,2.625,5.829). (Table 2)Conclusions: Studies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1C is independently associated with the risk of CIN, and with the increase of HbA1C level, the incidence of CIN gradually increases.

show abstract

“…The glucose-lowering action of GLP-1RAs is glucose-dependent (occurring when blood glucose is elevated, such as after a meal), which results in a low risk of hypoglycemia, although hypoglycemia may occur when GLP-1RAs are Adapted with permission from [39]. used in combination with insulin or insulin secretagogues such as sulfonylureas [30]. GLP-1RAs are also associated with a reduction in body weight, possibly linked to suppression of appetite and delayed gastric emptying [40].…”

Section: Actions Of Glp-1 and Dulaglutidementioning

confidence: 99%

Glucagon-like peptide-1 Receptor Agonists and the Cardiorenal Axis in Type 2 Diabetes: A Focus On Dulaglutide

MacIsaac

2021

Future Cardiol.

View full text Add to dashboard Cite

Results from cardiovascular outcomes trials (CVOTs) in people with Type 2 diabetes (T2D), such as the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) study with dulaglutide, have led to a shift toward glucose lowering therapies that provide broad benefits, including cardiovascular (CV) risk reduction and renoprotection. Dulaglutide reduces atherosclerotic CV outcomes (hazard ratio 0.88; 95% CI: 0.79–0.99) and composite kidney outcomes (hazard ratio 0.85; 95% CI: 0.77–0.93) in people with T2D with high risk or established CV disease. The cardiologists’ role has now expanded to include not only screening for T2D and treating risk factors, but also recommending or incorporating glucose-lowering agents with proven CV benefit into the care of their patients with T2D.

show abstract

2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

Cited by 323 publications

References 91 publications

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HF_DM) in patients in the ACCORD trial

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HF_DM) in patients in the ACCORD trial

Glycosylated Hemoglobin levels and the Risk for Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary arteriography/Percutaneous Coronary Intervention

Glucagon-like peptide-1 Receptor Agonists and the Cardiorenal Axis in Type 2 Diabetes: A Focus On Dulaglutide

Contact Info

Product

Resources

About

2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

Cited by 323 publications

References 91 publications

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HFDM) in patients in the ACCORD trial

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HFDM) in patients in the ACCORD trial

Glycosylated Hemoglobin levels and the Risk for Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary arteriography/Percutaneous Coronary Intervention

Glucagon-like peptide-1 Receptor Agonists and the Cardiorenal Axis in Type 2 Diabetes: A Focus On Dulaglutide

Contact Info

Product

Resources

About

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HF_DM) in patients in the ACCORD trial

Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HF_DM) in patients in the ACCORD trial