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Practice Guideline
. 2020 Sep 1;76(9):1117-1145.
doi: 10.1016/j.jacc.2020.05.037. Epub 2020 Aug 5.

2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee

Sandeep R Das, Brendan M Everett, Kim K Birtcher, Jenifer M Brown, James L Januzzi Jr, Rita R Kalyani, Mikhail Kosiborod, Melissa Magwire, Pamela B Morris, Joshua J Neumiller, Laurence S Sperling
Practice Guideline

2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee

Sandeep R Das et al. J Am Coll Cardiol. .
No abstract available

Keywords: ACC Expert Consensus Decision Pathway; GLP-1RA; SGLT2 inhibitor; atherosclerotic cardiovascular disease; cardiovascular risk reduction; diabetes; type 2 diabetes.

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Figures

FIGURE 1
FIGURE 1. Summary Graphic
*ASCVD is defined as a history of an acute coronary syndrome or MI, stable or unstable angina, coronary heart disease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumed to be atherosclerotic in origin. †DKD is a clinical diagnosis marked by reduced eGFR, the presence of albuminuria, or both. Consider an SGLT2 inhibitor when your patient has established ASCVD, HF, DKD or is at high risk for ASCVD. ‡Consider a GLP-1RA when your patient has established ASCVD or is at high risk for ASCVD. §Patients at high risk for ASCVD include those with end organ damage such as left ventricular hypertrophy or retinopathy or with multiple CV risk factors (e.g., age, hypertension, smoking, dyslipidemia, obesity). ∥Most patients enrolled in the relevant trials were on metformin at baseline as glucose-iowering therapy. ASCVD = atherosclerotic cardiovascular disease; CV = cardiovascular; DKD = diabetic kidney disease; eGFR = estimated glomerular filtration rate; GLP-1RA = glucagon-like peptide-1 receptor agonist; HF = heart failure; MI = myocardial infarction; SGLT2 = sodium-glucose cotransporter-2; T2D = type 2 diabetes
FIGURE 2
FIGURE 2. Using an SGLT2 inhibitor to Manage ASCVD, HF, and DKD Risk
*ASCVD is defined as a history of an acute coronary syndrome or MI, stable or unstable angina, coronary heart disease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumed to be atherosclerotic in origin. †DKD is a clinical diagnosis marked by reduced eGFR, the presence of albuminuria, or both. ‡Patients at high risk for ASCVD include those with end organ damage such as left ventricular hypertrophy or retinopathy or with multiple CV risk factors (e.g., age, hypertension, smoking, dyslipidemia, obesity). §Most patients enrolled in the relevant trials were on metformin at baseline as glucose-lowering therapy. ∥This may include the addition of a GLP-1RA in the appropriate patient (see Section 5.3.3). ASCVD = atherosclerotic cardiovascular disease; CV = cardiovascular; DKD = diabetic kidney disease; eGFR = estimated glomerular filtration rate; GLP-1RA = glucagon-like peptide-1 receptor agonist; HF = heart failure; MI = myocardial infarction; SGLT2 = sodium-glucose cotransporter-2; T2D = type 2 diabetes
FIGURE 3
FIGURE 3. Using a GLP-1RA to Manage ASCVD Risk
*ASCVD is defined as a history of an acute coronary syndrome or MI, stable or unstable angina, coronary heart disease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumed to be atherosclerotic in origin. †Patients at high risk for ASCVD include patients with end organ damage such as left ventricular hypertrophy or retinopathy or with multiple CV risk factors (e.g., age, hypertension, smoking, dyslipidemia, obesity). ‡Most patients enrolled in the relevant trials were on metformin at baseline as glucose-lowering therapy. §This may include the addition of an SGLT2 inhibitor in the appropriate patient (see Section 5.3.3). ASCVD = atherosclerotic cardiovascular disease; GLP-1RA = glucagon-like peptide-1 receptor agonist; MI = myocardial infarction; SGLT2 = sodium-glucose cotransporter-2; T2D = type 2 diabetes
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