Prevention of Diabetes Macrovascular Complications and Heart Failure

Cardiovascular (CV) mortality in diabetes has declined substantially over the last 3 decades in high-income countries from a multifactorial approach targeting glucose, cholesterol, and blood pressure, and lower smoking rates. Additional CV gains may be achieved from large-scale weight loss, which ongoing trials are testing, and from delaying diabetes in those at highest risk. Finally, recent outcome trials support a role for (1) sodium/glucose cotransporter-2 inhibitors, which lower major adverse cardiovascular events but incident heart failure more strongly, and (2) glucagon-like peptide-1 receptor agonists, which lower atherothrombotic outcomes more consistently, including stroke and peripheral arterial disease.