According to expert consensus decision pathways, patients with T2D and clinical ASCVD who are on metformin therapy (or in whom metformin is contraindicated or not tolerated) should have an SGLT2 inhibitor or GLP-1 RA with proven cardiovascular benefit added to their treatment regimen. For patients not on existing metformin therapy, clinicians may consider the addition of an SGLT2 inhibitor or GLP-1 RA for cardiovascular risk reduction.
SGLT2 inhibitors appear to reduce major adverse cardiovascular events and the risk for heart failure but increase the risk for genital mycotic infections. GLP-1 RAs reduce major adverse cardiovascular events, though they are associated with transient nausea and vomiting. Both classes have benefits in reducing blood pressure and weight and carry a low risk for hypoglycemia.
According to recommendations on management of blood cholesterol by the ACC and AHA, patients 40-75 years of age with diabetes mellitus and an LDL-C level ≥ 70 mg/dL are advised to start moderate-intensity statin therapy without calculating their 10-year ASCVD risk.
For patients with T2D at high risk, an LDL-C reduction of at least 50% from baseline and a target LDL-C level < 1.8 mmol/L (< 70 mg/dL) is recommended.
Learn more about guidelines for atherosclerosis.
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Cite this: Yasmine S. Ali. Fast Five Quiz: Noncoronary Atherosclerosis Management - Medscape - Mar 01, 2021.