SGLT2 Inhibitors, GLP-1RAs Recommended in Type 2 Diabetes and CVD

By Kelly Young

Edited by David G. Fairchild, MD, MPH

New guidance from the American College of Cardiology recommends the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with type 2 diabetes and established clinical atherosclerotic cardiovascular disease to lower their CV risk. The recommendations are published in the Journal of the American College of Cardiology.

Clinicians should provide guideline-directed medical therapy (e.g., lipid-lowering treatment, antiplatelet therapy) and glucose-lowering treatment like metformin. At the same time, they should consider adding an SGLT2 inhibitor (empagliflozin is the preferred agent) or a GLP-1RA (liraglutide is preferred) with proven CV benefit following a discussion with the patient.

SGLT2 inhibitors have been associated with a 14% reduced risk for major adverse CV events relative to placebo. GLP-1RAs have been associated with up to a 26% risk reduction, but in some studies there was no significant benefit.

SGLT2 inhibitors increase the risk for genital mycotic infections. GLP-1RAs are associated with transient nausea and vomiting.