AHA: Few Americans With Diabetes Meet Heart Targets

Less than 20% of American adults with type 2 diabetes are meeting targets to reduce their risk for cardiovascular disease (CVD), according to a new scientific statement released by the American Heart Association (AHA).

This includes missing the mark on targets for HbA1c levels, blood pressure and LDL cholesterol, as well as being non-smokers, wrote Joshua J. Joseph, MD, MPH, of the Ohio State University College of Medicine in Columbus and chair of the statement writing group, and colleagues in Circulation.

The numbers get even more grim if you also incorporate weight into the equation, Joseph's group pointed out. Less than 10% of adults with type 2 diabetes met the above-mentioned targets and also maintained a BMI below 30 -- the cutoff for obesity.

And when looking at U.S. adults with type 2 diabetes and known atherosclerotic CVD, only 6.8% met the target goals for HbA1c levels, blood pressure, LDL cholesterol, and being non-smokers. Even worse, only 2.7% met these target goals and had a BMI under 30.

"Far too few people -- less than 20% of those with type 2 diabetes -- are successfully managing their heart disease risk, and far too many are struggling to stop smoking and lose weight, two key CVD risk factors," Joseph explained in a statement. "Healthcare professionals, the healthcare industry and broader community organizations all have an important role to play in supporting people with type 2 diabetes."

"This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and to develop new best practices to advance type 2 diabetes treatment and care and reduce CVD risk," he added.

A few of these evidence-based approaches in the new statement drew focus towards three main areas of patient management: using new antihyperglycemic agents that are also cardioprotective, controlling hypertension, and incorporating newer lipid-lowering therapies. The statement also emphasized the importance of other pharmacologic therapies, lifestyle interventions, and surgical treatments to help patients achieve these target goals.

One of the strategies listed in the statement's recommendations included incorporating SGLT2 inhibitors or GLP-1 receptor agonists into the patient's care regimen.

"Since 2015, a number of important national and international clinical trials that specifically examined new type 2 diabetes medications for lowering cardiovascular disease and cardiovascular mortality risk among people with type 2 diabetes have been completed," Joseph noted. "GLP-1 receptor agonists have been found to improve blood sugar and weight, and they have been game changers in reducing the risk of heart disease, stroke, heart failure, and kidney disease."

For example, the GLP-1 receptor agonist semaglutide is currently FDA approved at different doses for a slew of indications. At lower doses, injectable (Ozempic) is indicated for type 2 diabetes and to reduce risk of major cardiovascular events, including heart attack, stroke, and death. Semaglutide is approved for chronic weight management at the higher 2.4-mg dose (Wegovy).

As for incorporating lipid-lowering therapies, the statement noted how "[s]tatins are the cornerstone of lipid therapy in type 2 diabetes." However, beyond these agents, the statement authors also noted the benefits of ezetimibe, PCSK9 inhibitor therapy, bile acid sequestrants, and bempedoic acid.

The American Diabetes Association doesn't recommend a "uniform" blood pressure target for patients, the AHA statement pointed out, and instead uses a risk stratification model in order to "avoid overtreatment in frail patients with comorbidities and to decrease the potential of polypharmacy and adverse drug events."

Unlike the American College of Cardiology/AHA blanket target blood pressure target of under 130/80, the ADA said patients with high cardiovascular risk (existing atherosclerotic CVD or 10-year risk score of 15% or higher) should aim for a target under 140/90 or under 130/80 if it can be safely attained. The ADA's recommendations also suggested a higher target for needing dual antihypertensive therapy.

Most importantly, the statement calls for a personalized, patient-centered approach to managing all target goals to mitigate CVD risk in type 2 diabetes

"A patient-centered approach in this context means reframing our clinical encounters to think about patients as people who live in families, communities, and societies that must be considered in their cardiovascular risk management," Joseph's group said.

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