Following results from multiple large, randomized controlled trials of new antihyperglycemic medications, the American Heart Association (AHA) updated their statement regarding management of cardiovascular disease (CVD) risk in patients with type 2 diabetes (T2D). The updated AHA scientific statement was published in Circulation.

The AHA scientific statement was intended to focus on the evidence and clinical utility of newer antihyperglycemic agents in the improvement of glycemic control and reduction of CV events in patients with T2D; the impact of blood pressure control on CV events in patients with T2D; and the role of newer lipid-lowering agents in the comprehensive CVD risk management of adult patients with T2D.

The AHA scientific statement integrates current science and best practices for comprehensive management of CVD risk factors in adults with T2D. In addition, authors of the report provide context on the critical importance of social determinants of health and health equity in CVD risk factor management.


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Specifically, the scientific statement focuses on components of major adverse cardiovascular events (MACE), including coronary artery disease (CAD), cerebrovascular disease, and heart failure (HF). In individuals with T2D, several factors involved in the development of atherosclerosis and CVD are often comorbid, including hypertension, insulin resistance, hyperglycemia, obesity, and dyslipidemia. Both insulin resistance and hyperglycemia can trigger CAD, cerebrovascular disease, and HF.  

The scientific statement also underscores the continued importance of lifestyle interventions, pharmacologic therapy, and surgical interventions as a means of curbing the rapidly growing epidemic of obesity and metabolic syndrome, which are precursors to prediabetes, diabetes, and comorbid CVD, in the United States. Lifestyle management of T2D includes diabetes self-management education and support, physical activity, medical and nutritional therapy, smoking cessation, and psychosocial care. Authors of the report noted that greater adherence to a healthy lifestyle among adults with T2D is linked to a significantly lower risk for incident CVD and death.

Regarding physical activity, the American Diabetes Association (ADA) has recommended 150 minutes or more of moderate- to vigorous-intensity aerobic activity per week, for at least 3 days, with no more than 2 consecutive days without activity among most adults with T2D. In individuals with T2D, a tailored nutrition plan is also a key component of CVD risk reduction, with a heart-healthy dietary pattern recommended for improving glycemic control, attaining weight loss when necessary, and improving other atherosclerotic CVD risk factors. Being overweight (body mass index [BMI],  >25) or obese (BMI >30) with central or visceral adiposity has previously been associated with adverse CVD outcomes. Dietary, physical activity, and behavioral therapy are recommended for individuals with all BMI levels. Pharmacologic and surgical interventions are recommended for weight management in individuals with obesity.

The updated AHA statement also includes guidance on glycemic targets and control in T2D; randomized controlled CVD outcomes trials (CVOTs) of newer antihyperglycemic agents; treatment with sodium-glucose cotransporter-2 inhibitors; assessment of insulin degludec, aleglitazar, and pioglitazone; regulatory approvals, roles, and indications for newer antihyperglycemic drugs for CVD risk reduction; risk for hypoglycemia and related CV events; blood pressure management; lipid abnormalities and lipid-lowering therapies; antithrombotic therapy; screening for CV and renal complications; traditional and new imaging tests in the evaluation of subclinical CVD; and clinical implications of recent CVOTs.

Authors of the report noted that although effective therapies are available to improve CVD risk factors in the US and the world, the comprehensive management of various CVD risk factors in adults with T2D remains poor. In the US, the AHA and ADA have partnered in the groundbreaking program “Know Diabetes by Heart,” which supports patients, communities, professionals, and health care systems to address CV deaths, heart attacks, and stroke in individuals with T2D by increasing awareness of the relationship between diabetes and CVD, empowering patients, and supporting health care professionals in patient engagement and prevention of CVD.

Authors concluded, “Cardiovascular risk management from global risk assessment through individual- and population-level interventions to increase the control of cardiovascular risk factors in T2D are critical to the AHA mission to be a relentless force of longer and healthier lives.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Joseph JJ, Deedwania P, Acharya T, et al; on behalf of the American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; and Council on Hypertension. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association. Circulation. Published online January 10, 2022. doi:10.1161/CIR.0000000000001040