Beyond HbA1c cardiovascular protection in type 2 diabetes mellitus

Cardiovascular disease is a significant cause of morbidity and mortality for individuals living with type 2 diabetes mellitus (T2DM). These patients have double the risk of atherosclerotic cardiovascular disease (ASCVD) compared with the general population. Furthermore, approximately a third of T2DM patients live with established ASCVD. The traditional ‘glucocentric’ approaches to managing T2DM have failed to mitigate the burden of ASCVD. In recent years, some cardiovascular outcome trials of the sodium glucose-2 cotransporter inhibitors (SGLT2i) and the glucagon-like peptide-1 receptor agonists (GLP-1RA) have demonstrated an ability to reduce secondary cardiovascular events significantly. These therapies have ushered in an era of ‘thinking beyond HbA1c’ when treating T2DM patients. There is now a renewed focus on assessing patients for ASCVD risk and adding these novel therapies early to mitigate the adverse cardiovascular events that have become familiar to this population. While the exact physiological mechanisms underlying these clinical benefits are not yet explicitly defined, both the glycaemic benefits and other pleiotropic effects improve the metabolic milieu. This review will discuss the burden of cardiovascular disease (CVD) in T2DM and present a summary of these new antidiabetic drug classes proven to reduce CVD in T2DM.