American Heart Association Reveals Comprehensive Guidance to Control the Risk of Heart Disease in T2D Patients

Data suggest that fewer than twenty percent of patients with type 2 diabetes are lowering their risk of heart disease, prompting prominent doctors to demand immediate action. 

Diabetes is highly prevalent in the United States, and patients who have diabetes have a greater chance of developing many health conditions, including heart disease. Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in patients with type 2 diabetes. Patients with obesity, prediabetes, and diabetes and metabolic syndrome have a CVD risk that is nearly doubled. The American Heart Association’s newly issued scientific statement examines the gap between existing evidence on lowering CVD risk in people with type 2 diabetes (T2D) and the reality for such people. According to the study, managing blood glucose, blood pressure, and cholesterol levels, increasing physical activity, healthy diet, weight management, psychosocial care, avoiding smoking, and drinking alcohol are all targets for lowering CVD risk in type 2 diabetes. The researchers added that diabetes patients who live a healthier lifestyle have a lower risk of CVD and CVD death. The statement also emphasizes new research on treating T2D, encouraging physicians and patients to reassess and update their T2D management plans to include CVD risk factors, including smoking and obesity, the two main CVD risks. The American Heart Association’s Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health commissioned the volunteer writing group to create the scientific statement. Scientific statements from the American Heart Association are created to help people learn more about cardiovascular illnesses and thrombotic events and make better health care decisions. 

According to the study, GLP-1 (glucagon-like peptide-1) receptor agonists have been shown to improve blood sugar and weight and reduce the risk of heart disease, stroke, heart failure, and renal disease. Sodium-glucose co-transporter 2(SGLT-2) inhibitors –oral drugs including canagliflozin, dapagliflozin, ertugliflozin, and empagliflozin — have also been demonstrated to reduce the risk of CVD and chronic kidney disease. SGLT-2 inhibitors encourage the kidneys to excrete excess glucose through urine, lowering the risk of heart failure and slowing the renal function decline that is typical in type two diabetes. The statement highly recommends individualized treatments for patients with high blood pressure. These strategies should reduce hypertension medication’s negative consequences while avoiding over-treating vulnerable people. Statins are still the first line of lipid-lowering therapy for high triglyceride levels. However, the American Heart Association recommends that people who cannot take statins or do not meet their LDL cholesterol goals with statins consider other options. Depending on the individual’s overall health status and other medical issues, these options may include ezetimibe, bempodoic acid, bile acid resins, fibrates, and PCSK-9 inhibitors. 

According to the study findings, type 2 diabetes affects more than 34 million people in the United States, roughly 11 percent. Fewer than 20 percent of these populations are lowering their risk of heart disease, prompting prominent doctors to demand immediate action. According to the scientific statement, new techniques to manage blood sugar, including GLP-1 agents and SGLT-2 inhibitors, effectively treat type 2 diabetes. Although the cost of some diabetic medications may be a deterrent to taking them as recommended, many of these treatments are now more widely covered by more health insurance policies. The scientific statements summarize what is currently known about current practice and what areas require further investigation. This study suggests employing a patient-centered approach to address all cardiovascular risk factors in type 2 diabetes patients, including blood glucose levels, blood pressure, lipid abnormalities, thrombotic risk, obesity, and smoking, by combining lifestyle and medication therapies with proven benefits. The scientific statements may lead to guidelines, but they do not provide therapeutic recommendations. The guidelines of the American Heart Association are the organization’s official clinical practice recommendations.  

Practice Pearls: 

• Cardiovascular disease is one of the leading causes of morbidity and mortality in patients with type 2 diabetes. 
• In the United States, fewer than one in every five persons with type 2 diabetes meets recommended targets for lowering their risk of heart disease. 
• To improve heart health in patients with type 2 diabetes, innovative, evidence-based treatments that address social determinants of health and other treatment barriers must be implemented. 

Joseph JJ, Deedwania P, Acharya T, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: A scientific statement from the American Heart Association. Circulation. 2022;145(9). doi:10.1161/cir.0000000000001040  

Betsy Adegborioye, PharmD Candidate 2022, South College School of Pharmacy