CMHC Pulse Blog

The Spectrum of Cardiovascular Prevention: Obesity Paradox, Physical Activity, Sedentary Behaviors and Emerging Therapeutics in Type 2 Diabetes Mellitus

GLP-1 RAs such as liraglutide22, semaglutide23 and albiglutide24 have shown a strong signal in prevention of atherosclerotic cardiovascular disease as well as renal events in patients with T2DM, although not all agents in this class have shown uniformity in this aspect. Based on these results, updated diabetes guidelines recommend that in T2DM patients with atherosclerotic cardiovascular disease, we should use GLP-1 RAs, and in T2DM patients with heart failure or chronic kidney disease, we should use an SGLT-2 inhibitor after first-line therapy with lifestyle and metformin.25 The type of agent that we ultimately choose to address cardiovascular risk in patients with T2DM also depends on the patients’ characteristics and comorbidities; for example, most GLP-1 RAs have very favorable metabolic effects by promoting significant weight loss, which is clearly desirable in obesity, while SGLT-2 inhibitors exert a much stronger effects on blood pressure. So, if a patient is concerned about their weight or blood pressure, treatment needs to be individualized accordingly.26 Finally, when one of these agents is not sufficient to achieve glycemic goals, a combination of GLP1-RAs and SGLT-2 inhibitors should also be considered.

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