Results of recent cardiovascular outcome studies have shown significant reductions in cardiovascular disease and overall mortality using sodium–glucose cotransporter-2 inhibitors and glucagon- like peptide-1 receptor agonists and have made us rethink our choices of pharmacotherapy. These agents should now be considered earlier in the management of patients with type 2 diabetes to reduce cardiovascular risk, particularly in those with existing cardiovascular disease.
- Type 2 diabetes is associated with a significant increase in cardiovascular risk.
- Early glycaemic control reduces microvascular complications that in the long term may also translate to decreased macrovascular complications.
- Traditional antihyperglycaemic agents do not appear to have any specific beneficial cardiovascular effects, with the possible exception of metformin.
- More recently, some trials have shown significant reductions in cardiovascular and overall mortality using sodium–glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists in specific patient populations, particularly in those with established cardiovascular disease.
- SGLT-2 inhibitors may also reduce hospitalisation with heart failure.
- These agents should now be considered earlier in the management of patients with type 2 diabetes to reduce cardiovascular risk, particularly in those with existing cardiovascular disease.
- Management of each patient should be individualised; if these newer agents are used, the relative benefits and potential side effects should always be discussed with the patient.
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