2018 ACC Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease


The American College of Cardiology develops a broad range of policy documents to provide members with practical guidance on clinical topics. Expert Consensus Documents (now known as Expert Consensus Decision Pathways) are intended to provide clinician guidance in areas in which evidence may be new or evolving, or lack sufficient data to fully inform clinical decision-making. The purpose of this Expert Consensus Decision Pathway was to summarize key points from emerging studies and to provide succinct, practical guidance on the use of specific glucose-lowering agents for reducing cardiovascular (CV) risk in patients with type 2 diabetes (T2D) and clinical atherosclerotic CV disease.

The authors suggest that their recommendations provide a paradigm shift in how CV specialists should approach the care of patients with T2D. Previously, CV care in diabetes was focused on risk factor optimization, with medications used for glycaemic control not expected to provide CV benefit. The recent development of sodium glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1Ras) has demonstrated proven reduction in acute myocardial infarction, stroke, CV death and heart failure hospitalizations (the latter for SGLT2 inhibitors only) in large, randomized clinical trials.

In summary, the treatment algorithms proposed in this document should be used to complement existing guidelines for the prevention of major adverse CV events in T2D and should be applied in the context of guideline-directed diabetes care. As evidence for novel therapies is still emerging and further CV outcomes trials are ongoing, it is likely that the proposed treatment algorithms will change as further information arises.

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Das SR, Everett BM, Birtcher KK, et al. J Am Coll Cardiol 2018;72:3200–23.