TY - JOUR
T1 - Use of Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes and Cardiovascular Disease
T2 - A Review
AU - Honigberg, Michael C.
AU - Chang, Lee Shing
AU - McGuire, Darren K.
AU - Plutzky, Jorge
AU - Aroda, Vanita R.
AU - Vaduganathan, Muthiah
N1 - Funding Information:
reported receiving grants from Novo Nordisk and Sanofi during the conduct of the study as well as grants from Fractyl, Applied Therapeutics, and Boehringer Ingelheim outside the submitted work. Dr McGuire reported receiving personal fees from Boehringer Ingelheim, Sanofi-Aventis, AstraZeneca, Merck & Co, Pfizer, Novo Nordisk, Esperion, Lilly USA, Lexicon, GlaxoSmithKline, Applied Therapeutics, Metavant, and Afimmune outside the submitted work. Dr Plutzky reported receiving personal fees from Amarin, Amgen, Esperion, Janssen, and Novo Nordisk as well as grants from Boehringer Ingelheim. Dr Aroda reported receiving grants from Applied Therapeutics, Premier/Fractyl, Boehringer Ingelheim, Calibra, Eisai, Janssen, and Theracos outside the submitted work; personal fees from Becton Dickinson, Duke, and Zafgen; and grants and personal fees from AstraZeneca, Novo Nordisk, and Sanofi, as well as reported spouse employment by Janssen. Dr Vaduganathan reported receiving a grant from Harvard Catalyst and personal fees from Amgen, AstraZeneca, Baxter HealthCare, Bayer AG, Boehringer Ingelheim, Cytokinetics, and Relypsa outside the submitted work, as well as participating on clinical committees for studies sponsored by Novartis and the National Institutes of Health (NIH). No other disclosures were reported.
Funding Information:
Funding/Support: Dr Honigberg was supported by
Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/10
Y1 - 2020/10
N2 - Importance: Recent randomized clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce cardiovascular events in at-risk individuals with type 2 diabetes. Despite these findings, GLP-1RAs are underused in eligible patients, particularly by cardiologists. Observations: To date, randomized clinical trials of albiglutide, dulaglutide, liraglutide, and injectable semaglutide have reported favorable cardiovascular outcomes. Most recently approved for clinical use, oral semaglutide has a favorable safety profile and is currently undergoing regulatory evaluation and further study for cardiovascular outcomes. Professional society guidelines now recommend GLP-1RA therapy for cardiovascular risk mitigation in patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) or multiple ASCVD risk factors, independent of glucose control or background antihyperglycemic therapy (other diabetes medications being used). Additional conditions suitable for GLP-1RA therapy include obesity and advanced chronic kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2), for which cardiovascular risk-reducing options are limited. Out-of-pocket costs and secondary advantages (eg, weight loss) may inform shared decision-making discussions regarding potential therapies. GLP-1RA therapy has a favorable safety profile. Its most common adverse effect is gastrointestinal upset, which typically wanes during the early weeks of therapy and may be mitigated by starting at the lowest dose and escalating as tolerated. Depending on baseline glycemic control, sulfonylureas and insulin may need to be decreased before GLP-1RA initiation; without concurrent use of insulin or sulfonylureas, GLP-1RAs are not associated with hypoglycemia. Multidisciplinary follow-up and collaborative care with primary care physicians and/or endocrinologists are important. Conclusions and Relevance: Findings from this review suggest that GLP-1RAs are safe, are well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underused by cardiologists. This review provides a practical resource for cardiologists for initiating GLP-1RAs and managing the therapy in patients with type 2 diabetes and established ASCVD or high risk for ASCVD.
AB - Importance: Recent randomized clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce cardiovascular events in at-risk individuals with type 2 diabetes. Despite these findings, GLP-1RAs are underused in eligible patients, particularly by cardiologists. Observations: To date, randomized clinical trials of albiglutide, dulaglutide, liraglutide, and injectable semaglutide have reported favorable cardiovascular outcomes. Most recently approved for clinical use, oral semaglutide has a favorable safety profile and is currently undergoing regulatory evaluation and further study for cardiovascular outcomes. Professional society guidelines now recommend GLP-1RA therapy for cardiovascular risk mitigation in patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) or multiple ASCVD risk factors, independent of glucose control or background antihyperglycemic therapy (other diabetes medications being used). Additional conditions suitable for GLP-1RA therapy include obesity and advanced chronic kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2), for which cardiovascular risk-reducing options are limited. Out-of-pocket costs and secondary advantages (eg, weight loss) may inform shared decision-making discussions regarding potential therapies. GLP-1RA therapy has a favorable safety profile. Its most common adverse effect is gastrointestinal upset, which typically wanes during the early weeks of therapy and may be mitigated by starting at the lowest dose and escalating as tolerated. Depending on baseline glycemic control, sulfonylureas and insulin may need to be decreased before GLP-1RA initiation; without concurrent use of insulin or sulfonylureas, GLP-1RAs are not associated with hypoglycemia. Multidisciplinary follow-up and collaborative care with primary care physicians and/or endocrinologists are important. Conclusions and Relevance: Findings from this review suggest that GLP-1RAs are safe, are well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underused by cardiologists. This review provides a practical resource for cardiologists for initiating GLP-1RAs and managing the therapy in patients with type 2 diabetes and established ASCVD or high risk for ASCVD.
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U2 - 10.1001/jamacardio.2020.1966
DO - 10.1001/jamacardio.2020.1966
M3 - Review article
C2 - 32584928
AN - SCOPUS:85087153154
SN - 2380-6583
VL - 5
SP - 1182
EP - 1190
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 10
ER -