Management of Coronary Artery Disease and Type 2 Diabetes

Introduction to Guideline-Based Care

The European Society of Cardiology recommends empagliflozin as the cornerstone therapy for patients with both CAD and type 2 diabetes to reduce cardiovascular events and mortality, with a Class I recommendation and Level A evidence 1, 2, 3, 4

The European Society of Cardiology recommends empagliflozin to reduce the risk of death in patients with T2DM and CVD, with Class I, Level A evidence 1, 4
Empagliflozin decreases major adverse cardiovascular events including MI, stroke, and cardiovascular death 1, 2, 4
The American Diabetes Association and European Association for the Study of Diabetes suggest initiating empagliflozin at a dose of 10 mg daily, with consideration for dose adjustment if heart failure is present 4

The American Heart Association and American College of Cardiology recommend ACE inhibitors or ARBs in all patients with DM and CAD to reduce cardiovascular events, with a Class I recommendation 1, 2, 3
ACE inhibitors or ARBs reduce the risk of major cardiovascular events, heart failure hospitalization, and death 1, 2, 3

The American College of Cardiology recommends statin therapy in all patients with DM and CAD to reduce cardiovascular events, with a Class I recommendation 1, 2, 3
The target LDL-C is <1.4 mmol/L (<55 mg/dL) with at least 50% reduction from baseline in very high CV risk patients 1, 2, 3

The American Heart Association recommends aspirin 75-160 mg/day for secondary prevention in patients with DM and CAD 1, 2, 3
Dual antiplatelet therapy (aspirin + ticagrelor or prasugrel) is recommended for 1 year in patients with acute coronary syndrome 1, 2

The European Society of Cardiology recommends liraglutide, semaglutide, or dulaglutide in patients with T2DM and CVD to reduce cardiovascular events 1, 2, 3
Liraglutide specifically reduces the risk of death in this population 1, 2, 3

The American Heart Association and American College of Cardiology recommend against the use of thiazolidinediones (pioglitazone, rosiglitazone) due to increased risk of heart failure, with a Class III recommendation 2, 3, 5
Saxagliptin is not recommended due to increased risk of heart failure hospitalization, with a Class III recommendation 1, 2, 5