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Practice Guideline
. 2018 Dec 18;72(24):3200-3223.
doi: 10.1016/j.jacc.2018.09.020. Epub 2018 Nov 26.

2018 ACC Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways

Sandeep R Das, Brendan M Everett, Kim K Birtcher, Jenifer M Brown, William T Cefalu, James L Januzzi Jr, Rita Rastogi Kalyani, Mikhail Kosiborod, Melissa L Magwire, Pamela B Morris, Laurence S Sperling
Practice Guideline

2018 ACC Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways

Sandeep R Das et al. J Am Coll Cardiol. .
No abstract available

Keywords: ASCVD; Expert Consensus Decision Pathway; GLP-1RA; SGLT2 inhibitor; T2D; cardiovascular risk reduction; diabetes.

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Figures

FIGURE 1
FIGURE 1. Summary Graphic
*Most trials of SGLT2i and GLP-1RA required baseline A1C ≥7% (Example: EXSCEL Trial required HbA1c ≥ 6.5%), and most patients were already on metformin as first-line therapy if tolerated and not contraindicated Abbreviations: ASCVD = atherosclerotic cardiovascular disease; CV = cardiovascular; GLP-1RA = glucagon-like peptide-1 receptor agonist; SGLT2 = sodium-glucose cotransporter-2; T2D = type 2 diabetes.
FIGURE 2
FIGURE 2. Approach to Managing Patients With Established ASCVD and T2D
*SGLT2 inhibitors and GLP-1RA have not been studied in and do not have an FDA -approved indication for patients with type 1 diabetes. †Some cardiovascular outcome trials included primary prevention patients with multiple risk factors for ASCVD. ‡ The available evidence for cardiovascular event reduction in patients with T2D and clinical ASCVD is derived from trials in which most participants were treated with metformin at baseline. Please see “Do Patients Need to Be on Metformin Before Initiating an SGLT2 Inhibitor or a GLP-1RA?” section in text. **Please see Table 12 and Table 13. If A1C well-controlled at baseline, or known history of frequent hypoglycemic events, reduce dose of sulfonylurea by 50% or basal insulin dose by 20% when starting therapy. Abbreviations: ASCVD = atherosclerotic cardiovascular disease; ESRD = end-stage renal disease; FDA = Food and Drug Administration; GLP-1RA = glucagon-like peptide-1 receptor agonist; SGLT2 = sodium-glucose cotransporter-2; T2D = type 2 diabetes; y/o = years old
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References

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