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Mayo Clin Proc. 2018 Nov;93(11):1629-1647. doi: 10.1016/j.mayocp.2018.07.018.

Glucose-Lowering Therapies for Cardiovascular Risk Reduction in Type 2 Diabetes Mellitus: State-of-the-Art Review.

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VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA. Electronic address:
Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA.
Division of Cardiovascular Medicine and Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA.
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA.


Type 2 diabetes mellitus (T2DM) is a major cardiovascular (CV) risk factor. Although antihyperglycemic therapies have typically focused on glycemic control, a paradigm shift for the treatment of T2DM has occurred, with an increased focus on CV risk reduction. Clinicians should base their clinical decisions on the beneficial effects of specific glucose-lowering agents on CV outcomes, while avoiding those therapeutic strategies with potential detrimental effects. Importantly, the presence of comorbidities (eg, established cardiovascular diseases, hypertension, obesity) should also guide the clinical decision toward therapies proven to reduce CV outcomes in that specific population. In this state-of-the-art review resulting from a comprehensive literature search (Pubmed, Google Scholar), we summarize the evidence related to the CV outcomes trials reported in the past several decades. Finally, we propose a therapeutic plan for patients with T2DM, suggesting the use of specific glucose-lowering agents based on the characteristics and presence of comorbidities of the individual patient.

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