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Curr Vasc Pharmacol. 2019 May 6. doi: 10.2174/1570161117666190426162746. [Epub ahead of print]

Pharmacological Management of Cardiac Disease in Patients with Type 2 Diabetes: Insights into Clinical Practice

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1
Second Propedeutic Department of Internal Medicine, General Hospital ``Hippokration``, Aristotle University of Thessaloniki, Thessaloniki, Greece

Abstract

Background:

Type 2 diabetes (T2D) has emerged as a growing pandemic. Cardiovascular disease (CVD) constitutes another major health problem, with coronary heart disease being the leading cause of cardiovascular death. Patients with T2D require a multilevel therapeutic approach, both for primary and secondary prevention of CVD.

Objective:

To present and summarize the most recent, highest level evidence retrieved from literature, relevant to the pharmaceutical management of CVD in T2D.

Method:

We conducted a comprehensive research of the literature, searching MEDLINE from its inception till 5thOctober 2018, primarily for relevant systematic reviews, meta-analyses and randomized controlled trials.

Results:

There is a trend towards more intensified therapeutic interventions in T2D, concerning glycemic, lipid and blood pressure control. New drugs, such as SGLT-2 inhibitors, GLP-1 agonists and PCKSK9 inhibitors might evolve as key players in the management of diabetes and its complications within the next years. Classic drugs, such as those targeting renin-angiotensin-aldosterone system, statins and aspirin remain first-line treatment options, both for primary and secondary prevention of CVD. Lifestyle interventions should always be integrated into a complete therapeutic strategy in diabetic patients. Novel drugs, such as finerenone, LCZ696 and canakinumab have provided significant results in cardiovascular outcome studies; however, their role in type 2 diabetes has to be further elucidated.

Conclusion:

Pharmaceutical approach of CVD in T2D is multilevel and complex. Drug classes featuring pleiotropic effects may booster our armamentarium in the fight against CVD.

KEYWORDS:

type 2 diabetes; cardiovascular disease; mortality; prevention

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