AHA Releases Scientific Statement Addressing CVD for Individuals with T2D

Although fewer than 1 in 5 adults with type 2 diabetes (T2D) are meeting targets to reduce heart disease rise, available therapies can help address this issue when combined with new approaches that address social determinants of health and other barriers to care, according to a scientific statement published by the American Heart Association (AHA).

The statement, published in the AHA’s journal, Circulation, is based on the writing group’s extensive review of clinical trial results through June 2020 and addresses the gap of existing evidence on how to lower cardiovascular risk for individuals with T2D.

“This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and to develop new best practices to advance T2D treatment and care and reduce [cardiovascular (CVD)] risk,” Joshua Joseph, MD, MPH, FAHA, chair of the statement writing group and an assistant professor of medicine in the division of endocrinology, diabetes, and metabolism at the Ohio State University College of Medicine, said in a statement.

“Far too few people, less than 20% of those with T2D, are successfully managing their heart disease risk, and far too many are struggling to stop smoking and lose weight, 2 key CVD risk factors. Health care professionals, the health care industry and broader community organizations all have an important role to play in supporting people with T2D,” Joseph said.

The statement suggests that a greater adherence to an overall healthy lifestyle among individuals with T2D is associated with a substantially lower risk of CVD and CVD-related mortality.

The suggestions include to address obesity and weight management, develop healthy nutrition, identify psychosocial care, increase physical activity, manage blood glucose, blood pressure, and cholesterol levels, and stop drinking and smoking.

The last scientific statement on blood sugar control was published in 2015, and since then, new important international and national clinical trials have examined associations between T2D medications for lowering CVD and CVD mortality risk, Joseph said.

“Glucagon-like pepdite-1 (GLP-1) receptor agonists have been found to improve blood sugar and weight, and they have been game-changers in reducing the risk of heart disease, stroke, heart failure, and kidney disease,” he said.

GLP-1 medications, in the form of injections, stimulate the release of insulin to control blood sugar, which can help reduce appetite and help people with weight loss or management.

In addition, sodium-glucose co-transporter 2 (SGLT-2) inhibitors, in the form of oral medications, can also reduce CVD and chronic kidney disease. SGLT-2 can activate the kidneys to dispose of excessive glucose through the urine, which lowers the risk of heart failure and slows the decrease of kidney functions that is common with T2D.

The new statement also highlights that individualized approaches to high blood pressure should be considered as ways to minimize the adverse effects of hypertension treatment and avoid potentially over-treating frail individuals.

Additionally, the AHA suggested other types of medications may be considered for those who do not tolerate statin medications, the first line of lipid-lowering therapy, or who are not reaching their low-density lipoprotein cholesterol targets. Medications may include bempodoic acid, bile acid resins, ezetimibe, fibrates, and PCSK-9 inhibitors, depending on the individual’s overall health status and other health conditions.

The AHA also addressed aspirin use among adults aged 65 years and older with T2D who are more likely than those who do not have T2D to take a daily low-dose aspirin to help prevent CVD.

However, recent research results suggest an increased risk of major bleeding from aspirin, and it could outweigh the benefits of a daily low-dose aspirin, and antiplatelet medications may be more effective for some individuals, according to the AHA.

The statement reinforced the importance of comprehensive, individualized, and multidisciplinary approaches to reduce CVD risk in individuals with T2D.

Shared decision-making between individuals with T2D and health care professionals and tailored plans can help manage the risk, the AHA said.

Tailored plans should include the individual’s preferences; potential cost concerns; support to effectively manage T2D and take medication as prescribed, including diabetes self-management education and support; support of healthy lifestyle choices; and treatment for any other CVD risk factors.

The statement also highlights evidence on treating T2D that could help health care professionals and individuals with T2D review and update their management plans to address CVD risk factors, including the importance of lowering cholesterol levels, new ways to control blood sugar, personalized blood pressure control, and re-thinking aspirin use.

Reference

Less than 1 in 5 adults with type 2 diabetes in the US are meeting optimal heart health targets. EurekAlert. News release. January 10, 2022. Accessed January 10, 2022. https://www.eurekalert.org/news-releases/939462