The American College of Cardiology has issued an expert consensus decision pathway (ECDP) to guide cardiovascular specialists in the initiation and monitoring of diabetes medications with the express goal of reducing cardiovascular risk. The document was published today in the Journal of the American College of Cardiology.
Despite major therapeutic advances leading to improved outcomes, cardiovascular disease remains the leading cause of morbidity and mortality in patients with Type 2 diabetes. Previously, cardiovascular specialists focused on encouraging exercise, smoking cessation, and lowering cholesterol and blood pressure, as well as improving other risk factors for cardiovascular disease. While controlling blood glucose has been important to minimizing the eye and kidney complications of diabetes, it has had less of an impact on heart attack and stroke. However, over the past few years, two classes of medications that were initially approved for their effects on blood glucose have been shown to have important effects on heart attack, stroke, heart failure, diabetic kidney disease and death from cardiovascular causes. These classes are called the sodium-glucose cotransporter 2 inhibitor (SGLT2i) class and the glucagon-like peptide 1 receptor agonist (GLP-1RA) class.
Because of the important benefits of these new drug classes on cardiovascular outcomes that cardiologists focus on—like heart attack, stroke, heart failure, and cardiovascular death—this new guidance encourages cardiologists to consider them as part of their armamentarium to prevent cardiovascular disease in patients with diabetes.
“An important paradigm shift in the care of patients with diabetes and cardiovascular disease is underway,” said Sandeep R. Das, MD, MPH, FACC, co-chair of the writing committee for this Expert Consensus Decision Pathway. “Patients and physicians can now choose from a number of medications that have important proven benefits on cardiovascular and renal outcomes, in addition to their effects on blood glucose.”
This ECDP updates the 2018 ACC Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease with data from emerging studies and is intended to complement established risk factor modification guidelines and be applied in the context of guideline-directed diabetes care.
“Cardiologists play an integral role in preventing and treating cardiovascular disease in patients with Type 2 diabetes,” said Brendan M. Everett, MD, MPH, FACC, co-chair of the writing committee for this Expert Consensus Decision Pathway. “We should consider these new medications as important tools to reduce cardiovascular morbidity and mortality in patients with Type 2 diabetes. We can work together with our patients and other members of the care team to decide whether the patient would benefit from these therapies, and to initiate therapy if appropriate.”