2022 Canadian Cardiovascular Society Guideline for Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors for Cardiorenal Risk Reduction in Adults

Authors

G.B. John Mancini
Eileen O'Meara
Shelley Zieroth
Mathieu Bernier
Alice Y.Y. Cheng
David Z.I. Cherney
Kim A. Connelly
Justin Ezekowitz
Ronald M. Goldenberg
Lawrence A. Leiter
Gihad NesrallahFollow
Breay W. Paty
Marie-Eve Piche
Peter Senior
Abhinav Sharma
Subodh Verma
Vincent Woo
Pol Darras
Jonathan Y. Gabor
Jean Gregoire
Eva Lonn
James A. Stone
Jean-Francois Yale
Colin Yeung
Deborah Zimmerman

Document Type

Article

Publication Date

8-2022

Journal

Canadian Journal of Cardiology

First Page

1153

Last Page

1167

URL with Digital Object Identifier

https://doi.org/10.1016/j.cjca.2022.04.029

Abstract

This guideline synthesizes clinical trial data supporting the role of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors (SGLT2i) for treatment of heart failure (HF), chronic kidney disease, and for optimizing prevention of cardiorenal morbidity and mortality in patients with type 2 diabetes. It is on the basis of a companion systematic review and meta-analysis guided by a focused set of population, intervention, control, and outcomes (PICO) questions that address priority cardiorenal end points. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system and a modified Delphi process were used. We encourage comprehensive assessment of cardiovascular (CV) patients with routine measurement of estimated glomerular filtration rate, urinary albumin-creatinine ratio, glycosylated hemoglobin (A1c), and documentation of left ventricular ejection fraction (LVEF) when evaluating symptoms of HF. For patients with HF, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy for the reduction of hospitalization for HF when LVEF is > 40% and for the reduction of all-cause and CV mortality, hospitalization for HF, and renal protection when LVEF is ≤ 40%. In patients with albuminuric chronic kidney disease, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy to reduce all-cause and CV mortality, nonfatal myocardial infarction, and hospitalization for HF. We provide recommendations and algorithms for the selection of glucagon-like peptide-1 receptor agonists and SGLT2i for patients with type 2 diabetes and either established atherosclerotic CV disease or risk factors for atherosclerotic CV disease to reduce all-cause and CV mortality, nonfatal stroke, and for the prevention of hospitalization for HF and decline in renal function. We offer practical advice for safe use of these diabetes-associated agents with profound cardiorenal benefits.

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