Prevention of CV outcomes in antihyperglycaemic drug-naïve patients with type 2 diabetes with, or at elevated risk of, ASCVD: to start or not to start with metformin
Abstract
This editorial refers to ‘Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin: a subgroup analysis of the REWIND trial’, by G. Ferrannini et al., doi:10.1093/eurheartj/ehaa777. As well documented,1 , 2 a remarkable series of cardiovascular (CV) outcome trials have now convincingly shown that sodium glucose co-transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) lessen risk for atherosclerotic cardiovascular disease (ASCVD)-related major adverse CV events (MACE) in patients with type 2 diabetes (T2D). The SGLT2is have also been shown to lower risks of heart failure (HF) or chronic kidney disease (CKD),2 and benefit those with pre-existing HF with reduced ejection fraction3 or CKD, whether they have T2D or not. The arsenal with which to lessen adverse CV/cardiorenal complications in T2D has thereby been meaningfully expanded. Relevant professional societies have since revised their recommended treatment algorithms and Guidelines, including the European Society of Cardiology (ESC)4 and American Diabetes Association (ADA) in conjunction with the European Association for the Study of Diabetes (EASD).5 These societies and others now endorse the use of these two classes of drugs in patients with T2D and existing ASCVD or at high ASCVD risk, as well as to reduce risk for the incidence and progression of diabetic kidney…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 1,864 participants or records.
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