Cardiovascular Outcomes in Patients With Diabetes and Kidney Disease: JACC Review Topic of the Week

J Am Coll Cardiol. 2023 Jul 11;82(2):161-170. doi: 10.1016/j.jacc.2023.04.052.

Abstract

Chronic kidney disease (CKD) and cardiovascular disease (CVD) have a significant inter-relationship in patients with diabetes. Controlling blood pressure, dyslipidemia, and glucose levels is a common treatment approach to managing CVD risk in patients with CKD and diabetes; despite strict control, however, a high residual risk remains. This review focuses on patients who require pharmacotherapy, in whom new and existing cardiorenal therapies (renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists) with differing mechanisms of action and safety profiles can reduce cardiovascular risk beyond the outcomes achieved with blood pressure, dyslipidemia, or glycemic control alone. Several treatment guidelines have been updated recently to reflect new evidence. Studies of these cardiorenal agents used in combination are ongoing, and results are awaited with interest, with the hope that potential synergistic effects may lead to further improvements in cardiovascular outcomes.

Keywords: cardiovascular therapy, CKD; diabetes; heart failure.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases* / chemically induced
  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / prevention & control
  • Diabetes Mellitus, Type 2* / drug therapy
  • Dyslipidemias* / drug therapy
  • Glucose
  • Humans
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Renal Insufficiency, Chronic* / complications
  • Renal Insufficiency, Chronic* / epidemiology
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use

Substances

  • Sodium-Glucose Transporter 2 Inhibitors
  • Glucose
  • Mineralocorticoid Receptor Antagonists