Glucagon-Like Peptide 1 Receptor Agonists, Carotid Atherosclerosis, and Cardiovascular Outcomes.

Glucagon-like peptide 1 receptor agonists (GLP-1 RA) represent an integral part of the arsenal used in clinical practice to improve cardiovascular outcomes in patients with diabetes. Large-scale randomized controlled trials have shown that liraglutide, dulaglutide, albiglutide, and semaglutide all reduce the risk of cardiovascular events in patients with diabetes and either established atherosclerotic cardiovascular disease (ASCVD) or high-risk characteristics (1–4). In contrast, exenatide and lixisenatide improved glycemic control but did not have a sizable impact on cardiovascular events in clinical trials (5,6), suggesting that glycemic control and cardiovascular outcomes are at least partly uncoupled. A meta-analysis including 42,920 participants from five randomized trials demonstrated that GLP-1 RA as a drug class are associated with a significant 13% reduction in the risk of the composite of myocardial infarction, stroke, or cardiovascular death in patients with diabetes and established ASCVD (7). GLP-1 RA are recommended in patients with diabetes and established ASCVD or at high risk of ASCVD (8). They are also indicated as second-line therapy in patients without ASCVD (or without indicators of high risk) who do not meet treatment goals with lifestyle modifications and metformin alone, and they are preferred to insulin if injectable therapy is needed (8). Although the …