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Feature Article

Reducing cardiovascular risk in type 2 diabetes: can we do more?

Andrew Sindone, Roger Chen

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Abstract

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.

Key Points

  • 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.

    Picture credit: © milatas/stock.adobe.com
    
Model used for illustrative purposes only

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