New guidelines for diabetes and cardiovascular disease

Two large European organizations – the European Cardiology Society (ESC) in collaboration with the European Association for the Study of Diabetes  (EASD) – have released a new guidelines for patients with diabetes or prediabetic diseases related to the use of new drugs and the prevention of cardiovascular disease (CVD). The recommendations were presented at ESC Congress, and were also published in the European Heart Journal.

The guidelines presented in the 2019 show the recent positive results of large studies in cardiovascular morbidity using new drug groups (GLP-1 and SGLT2) against diabetes and other new developments. It also changes the existing approach by which the drug metformin was the only initial treatment for anyone with diabetes previously.

New  Risk Assessment System of CVD

A system for assessing the risks of cardiovascular diseases has been introduced to replace primary and secondary prevention – medium, high and very high.

The authors explain the new approach so that over the past 5 years, impressive documented evidence has been obtained on the efficiency of new drugs  – SGLT2 and GLP-1. These drugs are used to treat the type 2 diabetes or non-insulin-dependent diabetes, and significantly reduce the incidence of cardiovascular disease.

Guildelines classify patients with diabetes as follows:

Median Risk of Cardiovascular Disease (CVD)

• in young patients;
• without other CV risk factors;
• diabetes lasts less than 10 years.

High CV risk

• diabetes lasts more than ten years;
• at least one CV risk factor;
• no damage of the target organ;

Very high CV risk

• a damage to the cardiovascular system or other target organ;
• the presence of type 1 diabetes with the duration is longer than 20 years.

A new approach for prevention with GLP-1 or SGLT2 medications

Now, a modern approach for first-line therapy begins with metformin (metformin) + GLP-1 or SGLT2 for patients with type 2 diabetes and a high or very high CV risk.

The recommendations also point to a reduction in cardiovascular risk with GLP-1 is likely due to a decrease in atherosclerosis-related events, while SGLT2 inhibitors reduce the cardiovascular events associated with heart failure.

Additional recommendations presented in the new European diabetic guidelines

• The use of aspirin in diabetics. According to the ASCEND study, the new recommendation is to use aspirin only in diabetics with a high or very high CV risk.
• Therapy of LDL cholesterol. The recommendations tell about the use of PCSK9 inhibitors if LDL above the norm in diabetics with a very high CV risk, as well as providing the maximum treatment with statins or ezetenib if ones are intolerant.
• Antiplatelet therapy. The COMPAS trial of rivaroxaban + aspirin in patients with diabetes and stable coronary heart disease led to the recommendation of this drugs combination for antiplatelet therapy with long-term CV prevention.
• Glycemic control. Antidiabetic treatment is recommended if hemoglobin A1c is above 7%, especially among young people who have recently been diagnosed with diabetes.

The document also recommends the use of lipid target to determine the risk of cardiovascular disease (CVD):

• For patients with an average CVD – less than 124 mg / dl,
• with high CVD – 160 mg / dl,
• with very high CVD –221 mg / dl.

Source: Emed, Israel.