Guidelines for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes
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Cardiovascular disease is a leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus. These high-risk patients benefit from aggressive risk factor management, with blood pressure and low-density lipoprotein-cholesterol treatment, glycemic control, kidney protection, and lifestyle intervention. There are several recommendation and guideline documents across cardiology, endocrinology, nephrology, and general medicine professional societies from the United States and Europe with recommendations for cardiovascular risk reduction in patients with type 2 diabetes mellitus. Although there are some noteworthy differences, particularly in risk stratification, low-density lipoprotein-cholesterol and blood pressure treatment targets, and the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, overall there is considerable alignment across recommendations from different professional societies.
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Individuals with diabetes and prediabetes often have barriers to exercise due to being frail or functionally compromised, making it difficult for them to tolerate long-lasting moderate-to-vigorous intensity physical activity as recommended (at least 150 min/week).
“However, individuals with diabetes and prediabetes often have barriers to exercise due to being frail or functionally compromised;9 therefore, tolerating long-lasting moderate-to-vigorous intensity PA (MVPA) as recommended (at least 150 min/week) is difficult for them.8”
From Accelerometer-measured physical activity, sedentary behavior, and incidence of macrovascular and microvascular events in individuals with type 2 diabetes mellitus and prediabetes (2025) · cites this paper as [8]
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Experimental — accuracy not yet measuredProfessional society guidelines recommend SGLT2 inhibitors and GLP-1 receptor agonists for patients with type 2 diabetes and established cardiovascular disease.
“Based on evidence from large cardiovascular outcomes trials, the latest professional society guidelines continue to recommend sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD).1,2”
Multiple professional societies issue recommendations for care of people with diabetes, CKD, or both.
“Multiple professional societies issue recommendations for care of people with diabetes, CKD, or both, 44 and the existence of multiple guidelines can create the appearance of inconsistency.”
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- Authors
- Kelsey, M. D., Nelson, A. J., Green, J. B., Granger, C. B., Peterson, E. D., McGuire, D. K., & Pagidipati, N. J.
- Affiliations
- Duke University (US)
- Duke Clinical Research Institute (US)
- Duke Medical Center (US)
- Parkland Health & Hospital System (US)
- Corresponding author
- Kelsey, Michelle D.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 79
- Issue
- 18
- Pages
- 1849-1857
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W4225270796
- Cited by
- 106
- References
- 48
- Citations by year
- 2026: 21 · 2025: 22 · 2024: 32 · 2023: 25 · 2022: 6
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- 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 › Blood Pressure and Hypertension Studies
- Keywords
- type 2 diabetes, cardiovascular risk reduction, cardiovascular disease, glycemic control, renal protection, lifestyle intervention, SGLT2 inhibitors, GLP-1 receptor agonists, risk stratification, professional society recommendations
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