2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes
Open accessAbstract
Ty J. Gluckman, MD, FACC, Chair Niti R. Aggarwal, MD, FACC Nicole M. Bhave, MD, FACC Gregory J. Dehmer, MD, MACC Olivia N. Gilbert, MD, MSc, FACC Chayakrit Krittanawong, MD Dharam J. Kumbhani, MD, SM, FACC Andrea L. Price, CPHQ, RCIS, AACC Javier A. Sala-Mercado, MD, PhD David E.
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Lifestyle intervention can reduce side effects in patients taking GLP-1 receptor agonists.
“Lifestyle intervention can also reduce side effects in patients taking GLP-1 receptor agonists including recommending smaller (and if needed, more frequent) meals that are lower in fat [14,86].”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [86]
In “What to Monitor When Prescribing a GLP-1RA,” the consensus says eating smaller portions and following a low-fat diet can help minimize nausea and vomiting. It does not recommend eating more frequently, even if needed. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe anti-inflammatory effects of GLP-1 RAs and SGLT2i are not fully elucidated.
“This gap in knowledge is especially pronounced in the case of glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i), which have shown promise in reducing cardiovascular and renal risks but whose anti-inflammatory effects are not fully elucidated.23”
From The effect of <scp>GLP</scp> ‐1 receptor agonists on circulating inflammatory markers in type 2 diabetes patients: A systematic review and meta‐analysis (2025) · cites this paper as [23]
The Introduction says the mechanisms behind cardiovascular and renal benefits remain uncertain, and the GLP-1RA Mechanisms of Action section identifies anti-inflammatory effects. The SGLT2 Inhibitors Mechanism of Action section also says its mechanisms of benefit are not fully elucidated. However, the paper does not specifically say that the anti-inflammatory effects of both drug classes are not fully elucidated; it does not identify anti-inflammatory effects for SGLT2 inhibitors. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe American Diabetes Association, the American College of Cardiology, and the European Society of Cardiology recommend that patients with type 2 diabetes with established or at risk of atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure be prescribed an SGLT2i or GLP-1 RA, irrespective of glycemic control or metformin use.
“These findings prompted the American Diabetes Association,2 the American College of Cardiology,3 and the European Society of Cardiology4 to recommend that patients with type 2 diabetes with established or at risk of atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure, be prescribed an SGLT2i or GLP-1 RA, irrespective of glycemic control or metformin use.”
From Race and ethnicity and pharmacy dispensing of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes (2024) · cites this paper as [3]
In general, comorbidities were independently associated with pharmacy dispensing of these drugs, which aligns with national guidelines.
“In general, comorbidities were independently associated with pharmacy dispensing of these drugs, which aligns with national guidelines.2, 3, 4”
From Race and ethnicity and pharmacy dispensing of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes (2024) · cites this paper as [3]
In an analysis of repeat hospitalization after first-ever lifetime stroke, diabetes was noted to increase the risk of repeat hospitalization for all causes.
“In an analysis of repeat hospitalization after first-ever lifetime stroke, DM was noted to increase the risk of repeat hospitalization for all causes.658”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [658]
The Introduction discusses elevated cardiovascular risk in people with type 2 diabetes, while the SGLT2 Inhibitors section discusses hospitalization for heart failure. Neither reports an analysis of all-cause repeat hospitalization after a first-ever stroke. Searches for first-ever stroke readmission and recurrent hospitalization found no passage addressing that claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
After an initial cerebrovascular accident, whether transient ischemic attack or stroke, the risk of recurrence and mortality increases.
“After the initial cerebrovascular accident (CVA), whether transient ischemic attack or stroke, the risk of recurrence and mortality increases.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [658]
The Definitions section lists prior stroke as a form of atherosclerotic cardiovascular disease, and the Description and Rationale sections discuss stroke and mortality as trial outcomes. No passage found addresses whether an initial stroke or transient ischemic attack increases the risk of recurrence and mortality; searches included those terms and recurrent stroke. Page numbers were unavailable in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredUpdated American Diabetes Association guidelines and the American College of Cardiology expert consensus statement now recommend SGLT2 inhibitor use for diabetic patients who have or are at high risk for cardiovascular disease, CKD, or heart failure regardless of current glycemic control.
“Given the demonstrated benefits of SGLT2 inhibitors, the updated American Diabetes Association guidelines10 and the American College of Cardiology expert consensus statement11 now recommend their use for diabetic patients who have or are at high risk for cardiovascular disease, CKD, or heart failure regardless of current glycemic control.”
From Association of race/ethnicity, gender, and socioeconomic status with sodium-glucose cotransporter 2 inhibitor use among patients with diabetes in the US (2021) · cites this paper as [11]
Guidelines from the ADA, ACC, and ESC endorse the use of GLP1-RA in treatment algorithms for ASCVD prevention for patients with T2D at elevated cardiovascular risk.
“This has led to guidelines from the ADA [45], the American College of Cardiology (ACC) [46], and the European Society of Cardiology (ESC)[47] endorsing the use of GLP1-RA in treatment algorithms for the purposes of ASCVD prevention for patients with T2D at elevated cardiovascular risk.”
From Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: a review of their kidney and heart protection (2023) · cites this paper as [46]
Multiple diabetes, cardiovascular, and kidney organizations endorse the use of GLP1-RA in their guideline recommendations.
“Despite multiple diabetes, cardiovascular, and kidney organizations endorsing the use of GLP1-RA in their guideline recommendations [45], [46], [47]”
From Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: a review of their kidney and heart protection (2023) · cites this paper as [46]
GLP-1 receptor agonists reduce major adverse cardiovascular events in patients with type 2 diabetes in both primary and secondary prevention settings.
“GLP-1RAs have been shown to reduce the incidence of major adverse CV events in patients with T2D, in the settings of both primary and secondary prevention.[18][19][20]”
From Management of type 2 diabetes, obesity, or nonalcoholic steatohepatitis with high‐dose GLP‐1 receptor agonists and GLP‐1 receptor‐based co‐agonists (2024) · cites this paper as [20]
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Diabetic Ketoacidosis and Related Events in the Canagliflozin Type 2 Diabetes Clinical Program
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Self-citation2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary
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Self-citationGLP-1 receptor agonists: a review of head-to-head clinical studies
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2019 Methodology for Creating Expert Consensus Decision Pathways
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2019 Methodology for Heart House Roundtables
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Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598 · see citing works
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- Authors
- Das, S. R., Everett, B. M., Birtcher, K. K., Brown, J. M., Januzzi, J. L., Kalyani, R. R., Kosiborod, M., Magwire, M., Morris, P. B., Neumiller, J. J., & Sperling, L. S.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 76
- Issue
- 9
- Pages
- 1117-1145
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC7545583
- OpenAlex
- W3047536039
- Semantic Scholar
- 6f3c96e39518ec999a6b97287d2a6d166e67b51b
- Cited by
- 466
- References
- 111
- Citations by year
- 2026: 41 · 2025: 75 · 2024: 52 · 2023: 67 · 2022: 117 · 2021: 104 · 2020: 10
- FWCI
- 56.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL007604)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Keywords
- type 2 diabetes, cardiovascular risk reduction, new drugs, cardiovascular disease prevention, expert consensus, decision pathways, SGLT2 inhibitors, GLP-1 receptor agonists
- MeSH terms
- Clinical Decision-Making, Heart Disease Risk Factors, Cardiology, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, United States, Committee Membership, Consensus, Risk Reduction Behavior, Research Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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