Diabetes: how to manage cardiovascular risk in secondary prevention patients

Abstract

Atherosclerotic cardiovascular disease (ASCVD) commonly affects people with type 2 diabetes (T2D). Historically, traditional cardiovascular (CV) risk-lowering therapies in patients with T2D and ASCVD have included antiplatelet agents, blood pressure-lowering therapies, lipid-lowering therapies and healthy lifestyle modifications. In the past decade, multiple antihyperglycaemic agents have emerged as CV risk-lowering therapies in this population as well. This article provides a narrative review on the current non-glycaemic and glycaemic treatment options for CV risk reduction in patients with T2D and ASCVD. The FDA requirement that all new antihyperglycaemic agents undergo cardiovascular outcomes trials has demonstrated increasing evidence to support the role of glucagon-like peptide 1 (GLP1) receptor agonists and sodium–glucose cotransporter 2 (SGLT2) inhibitors as first-line agents for both glycaemic control and CV risk reduction in this population.

Common mechanisms underlying diabetic vascular complications: focus on the interaction of metabolic disorders, immuno-inflammation, and endothelial dysfunction

“…Another exciting trial PRECIDENTD is currently in progress and is due to be completed in 2028. Up-to-now guidelines recommend the initiation of SGLT2 inhibitors or GLP1 receptor agonists with proven cardiovascular benefits in adult patients with T2DM [ 220 ]. PRECIDENTD trial will innovatively compare two drugs to prevent cardiovascular and diabetic kidney disease.…”