The Paradigm CV

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Liraglutide at a daily dose of 1. We suggest that metformin may be initiated at a submaximal dose given the mild hyperglycemia and optimized individually based on glycemic control and renal function. Our suggestion for early combination of metformin and a glucose-lowering agent with a proven cardiovascular benefit among T2DM patients with overt CVD is inspired by previous findings.

There is some evidence in literature that this benefit might extend to T2DM patients with milder degrees of hyperglycemia. Liraglutide in LEADER, significantly reduced nephropathy events, although this was predominantly driven by reduction in new-onset persistent macroalbuminuria [ 5 ]. Finally, while there is robust evidence for the efficacy of metformin on glycemic control and wide clinical experience support overall and CV safety, the CV efficacy of metformin remains uncertain. It should be noted that major conclusions regarding metformin benefit on selected CV outcomes were drawn from the UKPDS trial [ 15 ] and these observations have not been replicated in prospective trials, limiting the generalizability of results across T2DM patients with overt CVD.

Ongoing and further well-designed studies should assess and clarify the renal and CV efficacy and safety profile of liraglutide and empagliflozin across these groups of patients. United States Food and Drug Administration.


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Commentary Open Access. Cardiovascular benefit in the limelight: shifting type 2 diabetes treatment paradigm towards early combination therapy in patients with overt cardiovascular disease.

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Cardiovascular Diabetology 17 Keywords Diabetes mellitus type 2 Mild hyperglycemia Early combination therapy Cardiovascular disease Cardiovascular outcomes. Acknowledgements None. Competing interests The authors declare that they have no competing interests. Availability of data and materials Not applicable. Consent for publication Not applicable. Ethics approval and consent to participate Not applicable.

Funding None. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.

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N Engl J Med. Canagliflozin and cardiovascular and renal events in type 2 diabetes. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. Do not administer within 36 hours of switching from or to an ACE inhibitor. Angioedema associated with laryngeal edema may be fatal.

If hypotension persists despite dose adjustment of diuretics, concomitant antihypertensive drugs, and treatment of other causes of hypotension e. Permanent discontinuation of therapy is usually not required. In patients whose renal function depends upon the activity of the renin-angiotensin-aldosterone system e. In patients with renal artery stenosis, monitor renal function.

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Avoid use with aliskiren in patients with renal impairment eGFR 2. In patients who are elderly, volume-depleted including those on diuretic therapy , or with compromised renal function, concomitant use of non-steroidal anti-inflammatory drugs NSAIDs , including COX-2 inhibitors, with ENTRESTO may result in worsening of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically. Monitor serum potassium periodically and treat appropriately, especially in patients with risk factors for hyperkalemia such as severe renal impairment, diabetes, hypoaldosteronism, or a high potassium diet.

Concomitant use of potassium-sparing diuretics e. Lithium: Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists. Use of website is governed by the Terms of Use and Privacy Policy.

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