Dr Nikolaus Marx: New Recommendations on Lifestyle Modification, Glucose-Lowering Agents for Comorbid Diabetes, CVD

Nikolaus Marx, MD, professor of medicine/cardiology and head of the Department of Internal Medicine, University Hospital Aachen, Germany, discusses new guidelines recommending the use of sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists to reduce the risk of heart attack and stroke in patients with comorbid diabetes and cardiovascular disease (CVD).

Transcript

How can health care providers effectively encourage patients to incorporate lifestyle changes into their daily routines?

Lifestyle modification is the basis for everything we are doing, but we learned over time that it is important to implement certain strategies to help patients to do lifestyle modifications. One way is to do a multifactorial approach—so address several issues as you mentioned—but in addition to that, a patient-centered, person-centered approach. This means that we explain to the patient, provide help, and involve the family and other health care providers to really ensure that all the strategies that we use to reduce cardiovascular risks are implemented.

What recent trials shaped the new recommendations around SGLT2 inhibitors and GLP-1 receptor agonists for lowering the risk of heart attack and stroke in patients with diabetes and CVD?

Starting in 2015, large cardiovascular outcome trials with these—at that time—novel glucose-lowering agents, SGLT2 inhibitors and GLP-1 receptor agonists, were published. The results of these trials have led to a shift in paradigm in the treatment of patients with type 2 diabetes, and this has been summarized in the 2019 guidelines already. But since then, additional trials were published, like the AMPLITUDE-O trial, the VERTIS trial, and the results of these trials have also influenced our recommendations. So it was important to look at the combination of all the evidence [we have] to make the best treatment recommendation strategy.

A very important aspect of this guideline is that it has the component of screening, cardiovascular risk, stratification on the one hand, and then a person-centered, evidence-based therapeutic strategy to reduce cardiovascular risk. The presence of diabetes, as it informs us to give antiplatelet therapy, statins, [and] get the blood pressure down, it also informs us to give glucose-lowering agents with a proven benefit—SGLT2 inhibitors and GLP-1 receptor agonists—independent of glucose control and independent of concomitant medication. This is something that I'd like to emphasize here.