title: Integration of recent evidence into management of patients with atherosclerotic cardiovascular disease and type 2 diabetes.
abstract: Cardiovascular outcome trials of antihyperglycaemic drugs and non-statin LDL-cholesterol-lowering drugs in patients with type 2 diabetes who have, or who are at high risk of, atherosclerotic cardiovascular disease have provided new evidence that has substantially affected the management of cardiovascular risk in these patients. On the basis of proven cardiovascular and renal benefit, the antihyperglycaemic drugs empagliflozin, liraglutide, and semaglutide-the latter being under review for approval by the US Food and Drug Administration and the European Medicines Agency-should be preferentially used as second-line treatments in these patient populations, typically in addition to metformin. Further treatment differentiation among the remainder of the antihyperglycaemic drugs should be made on the basis of evidence regarding cardiovascular safety, which is available for lixisenatide, alogliptin, saxagliptin, sitagliptin, and insulin glargine. The risk of heart failure, stroke, or retinopathy, or prevalent fasting versus postprandial hyperglycaemia, could also be considered in treatment decision making. Finally, emerging evidence of cardiovascular benefit for ezetimibe, alirocumab, and evolocumab positions these drugs as add-ons to maximally tolerated statin therapy or for those with statin intolerance.
authors.affiliation: Munich Diabetes Research Group e.V. at Helmholtz Center, Neuherberg, Germany. Electronic address: eberhard.standl@lrz.uni-muenchen.de.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Standl
authors.affiliation: Munich Diabetes Research Group e.V. at Helmholtz Center, Neuherberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Schnell
authors.affiliation: University of Texas, Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer-IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; IRCCS MultiMedica, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ceriello
authors.affiliation: Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000150:complications* / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D007004:Hypoglycemic Agents