Cardiologist's approach to the diabetic patient: No further delay for a paradigm shift. (1st September 2021)

• Record Type: Journal Article
• Authors: Maranta, Francesco; Cianfanelli, Lorenzo; Gaspardone, Carlo; Rizza, Vincenzo; Grippo, Rocco; Ambrosetti, Marco; Cianflone, Domenico
• Is Part Of: International journal of cardiology. Volume 338(2021)
• Page Start: 248
• Page End: 257
• Publication Date: 2021-09-01
• Subjects: Glucose-lowering drugs -- Cardiovascular outcome trials -- Diabetes mellitus type 2 -- Cardiovascular risk -- SGLT-2 inhibitors -- GLP-1 receptor agonists; ACC/AHA American College of Cardiology/American Heart Association -- ASCVD atherosclerotic cardiovascular disease -- BP blood pressure -- CAD coronary artery disease -- CV cardiovascular -- CVOT cardiovascular outcome trial -- DM diabetes mellitus -- EMA European Medicines Agency -- ESC European Society of Cardiology -- FDA Food and Drug Administration -- GLD glucose-lowering drug -- GLP1-RA glucagon-like peptide-1 receptor agonists -- HbA1c glycated hemoglobin -- HF heart failure -- HFpEF heart failure with preserved ejection fraction -- HFrEF heart failure with reduced ejection fraction -- LDLc low-density lipoprotein cholesterol -- LV left ventricle -- MACE major adverse cardiovascular events -- PCSK9 proprotein convertase subtilisin/kexin type 9 -- SGLT-2i sodium-glucose linked transporter-2 inhibitors.; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.05.050
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Type 2 diabetes mellitus (DM) is constantly increasing worldwide and its most critical determinant of morbidity and mortality is still represented by cardiovascular (CV) complications. For years, cardiologists' approach to diabetic patients has been focused on risk factors optimization, with positive results. However, the management of DM per se was never truly considered in order to obtain prevention from major CV events, because medications used for glycemic control were not expected to gain CV benefit. Early trials concerning intensive versus conventional glycemia control did not prove useful in reducing the number of CV events. The introduction of new molecules led to a game change in DM treatment, as some new glucose-lowering drugs (GLDs), such as sodium-glucose linked transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA), showed not only to be safe but also to ensure CV benefit. A combination of anti-atherogenic effects and hemodynamic improvements are likely explanations of the observed reduction of CV events and mortality. These evidence opened a completely new era in the field of GLDs and of DM treatment. Nonetheless, the presence of residual cardiovascular risk despite optimal medical therapy remains an issue and an aggressive strategy against multiple risk factors is suggested. A paradigm shift toward a new approach to DM management should be made with no further delay with the use of medications that may prevent CV events in an integrated strategy of CV risk reduction. Highlights: Cardiovascular events remain the leading cause of mortality for diabetic patients. New glucose-lowering drugs showed cardiovascular benefit in randomized trials. New drugs remain underused and residual cardiovascular risk is still an issue. An actual shift toward a comprehensive approach in diabetes is needed.