Targeting multiple domains of residual cardiovascular disease risk in patients with diabetes

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Diabetes mellitus is associated with a significant increase in cardiovascular disease (CVD) risk.
• Despite previous improvements, a resurgence in diabetes-related CVD complications is currently observed.
• Secondary prevention strategies are crucial for managing residual cardiovascular risk in diabetic patients.

Purpose of the Study:

• To review established and emerging secondary prevention strategies for CVD in patients with diabetes.
• To highlight contemporary approaches that mitigate atherosclerotic and nonatherosclerotic CVD events.
• To discuss therapeutic targets including cardiometabolic pathways, lipoproteins, thrombosis, and inflammation.

Main Methods:

• Review of large-scale clinical trials and recent evidence.
• Analysis of pharmacological interventions including sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists.
• Evaluation of nonstatin lipid-lowering therapies, antiplatelet and anticoagulant strategies, and anti-inflammatory agents.

Main Results:

• Sodium-glucose cotransporter-2 inhibitors significantly reduce heart failure hospitalizations.
• Glucagon-like peptide-1 receptor agonists decrease the risk of major adverse cardiovascular events.
• Emerging evidence supports novel lipid-lowering, antiplatelet, anticoagulant, and anti-inflammatory therapies in select patients.

Conclusions:

• Multifaceted therapeutic approaches targeting distinct pathways improve cardiometabolic risk in diabetes.
• Individual patient characteristics and residual risk targets guide the selection of comprehensive secondary prevention.
• Optimizing secondary prevention is key to addressing the resurgence of cardiovascular complications in diabetes.