Risk management of cardiovascular disease in older patients with diabetes

The number of older patients with diabetes has been increasing due to Japan's rapidly aging population. As aging and diabetes are independent risk factors for cardiovascular disease, older adults face a higher risk of cardiovascular disease, with the incidence of heart failure and stroke increasing significantly with age. Preventing cardiovascular events is critical for this population to maintain their activities of daily living and improve their quality of life. To achieve this challenging purpose, it is essential to prioritize the use of glucose-lowering medications with proven cardiovascular benefits and to comprehensively manage risk factors, including blood pressure, as with younger patients. However, considering the vulnerability and divergent health status of older patients, population-specific effects and precautions regarding medications, such as sodium-glucose cotransporter (SGLT) 2 inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RA) should be considered. In particular, we must deliberate their impact on frailty when administering these medications to this population. In this mini review, we discuss the characteristics of older patients with diabetes and update the evidence on the consistent efficacy and safety of SGLT2 inhibitors and GLP-1RA in older patients. In addition, recent clinical trials that examined the effect of stricter blood pressure control in older patients with diabetes have been reconsidered to accomplish comprehensive risk management for preventing cardiovascular disease. Heterogeneity of older patients with diabetes and principles of cardiovascular risk management in this population. SGLT2: sodium glucose cotransporter 2, GLP-1RA: glucagon-like peptide 1 receptor agonist.