Use of GLP-1 RAs in Cardiovascular Disease Prevention: A Practical Guide.

Abstract

Although many cardiologists have not routinely prescribed antihyperglycemic agents, the results of cardiovascular outcome trials with sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like protein-1 receptor agonists (GLP-1 RAs), demonstrating significant reductions in cardiovascular events and mortality, make it imperative that cardiologists become more familiar with these agents. As part of a comprehensive cardiovascular risk reduction strategy, cardiologists can prescribe these agents or provide the recommendation to the healthcare team. In either case, involving the entire healthcare team, including the primary care provider and diabetologist/endocrinologist, ensures a team approach to manage potential patient concerns, side effects, and concomitant glucose-lowering medications. This article provides practical facts and tips to aid in the appropriate prescription of liraglutide, the first GLP-1 RA with a cardiovascular indication. Four cardiovascular outcomes studies evaluating GLP-1 RAs have been reported to date,1 of which only one2 showed unequivocally a superior cardiovascular outcome. The LEADER trial2 randomized 9340 patients with type 2 diabetes mellitus and high cardiovascular risk to liraglutide 1.8 mg or placebo in addition to standard of care. After a median follow-up of 3.8 years, participants in the liraglutide group experienced a significantly reduced risk (13.0% versus 14.9%; hazard ratio, 0.87; P =0.01) versus placebo for the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke).2 All individual components of the composite primary …