Primary versus secondary cardiorenal prevention in type 2 diabetes: Which newer antihyperglycaemic drug matters?

We are observing a resurgence of major diabetic vascular complications after a period of dramatic decrease in 1990-2010 years. The classical division of the cardiovascular prevention in primary (with an event) and secondary (without an event) is largely used to describe the cardiovascular risk in type 2 diabetes (T2D); however, there is evidence that the diabetic cardiovascular risk may range from the highest one in patients with a previous cardiovascular event to a mild one in patients with the main risk factors at target. Herein, we present details of the 14 cardiovascular outcome trials (CVOTs) published so far, including the total population investigated, and their separation into primary (T2D + multiple risk factors) and secondary prevention (T2D + established CVD) population as detailed within the trials; and summarize evidence for the effects of dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium glucose co-transporter-2 inhibitors (SGLT-2i) versus placebo on risk of MACE, HF and DKD. In primary prevention, SGLT-2i reduce both the risk of hospitalization for HF and progression of DKD; in secondary prevention, SGLT-2i are effective on the three endpoints, DPP-4i are neutral, while GLP1-RA show mixed results. This article is protected by copyright. All rights reserved.