Cardiology Group Recommends Diabetes Drugs for CV Prevention

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

New guidance from the American College of Cardiology suggests that for patients with diabetes and high cardiovascular risk, clinicians should consider prescribing sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists expressly to reduce CV risk. The expert consensus decision pathway was published in the Journal of the American College of Cardiology.

The group recommends that adults with type 2 diabetes who have atherosclerotic cardiovascular disease (ASCVD), heart failure, or diabetic kidney disease — or who are at high risk for ASCVD — should concurrently undergo guideline-directed preventive therapy (e.g., lifestyle changes, blood pressure and lipid management) and start an SGLT2 inhibitor or GLP-1 receptor agonist with proven CV benefits.

Appropriate SGLT2 inhibitors include canagliflozin, dapagliflozin, and empagliflozin. Options for GLP-1 receptor agonists include dulaglutide, liraglutide, and injectable semaglutide.

The decision should be informed by patient preferences, priorities, and medical history. For instance, some drugs have more favorable effects on heart failure prevention or weight loss.