{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T20:27:59Z","timestamp":1758054479387,"version":"3.44.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To explore the association of evidence-based cardiovascular preventive therapies with cardiovascular and renal outcomes in type 2 diabetes (T2DM) patients with established or high risk of atherosclerotic cardiovascular disease (ASCVD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this cohort study, we identified T2DM patients with established or high risk of ASCVD using diagnostic codes from the institutional data of Xiamen Humanity Hospital between 2018 and 2023. Cohort 1 includes participants who were visited between 2018 and 2020, with follow-up until occurrence of an endpoint or December 31, 2020. Participants who were visited between 2018 and 2023 were included in cohort 2. A total of 5,335 patients were included in cohort 1, and 17,320 patients were included in cohort 2. Primary outcomes were hazard ratios (HRs) for the composite of 3-point major adverse cardiovascular event (3-P MACE), hospitalization for heart failure (HHF), and end-stage kidney disease or doubling of serum creatinine level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Relative to patients\u2019 non-use of evidence-based cardiovascular preventive therapies, the use of at least one evidence-based cardiovascular preventive therapy was associated with a lower risk of the 3-P MACE (HR, 0.82; 95% confidence interval [CI], 0.67 to 0.98), HHF (HR, 0.66; 95% CI, 0.47 to 0.92) and end-stage kidney disease or doubling of the serum creatinine level (HR, 0.73; 95% CI, 0.60 to 0.89) after adjustment for potential confounders. From 2018 to 2023, the use of glucagon-like peptide 1 receptor agonists increased from 2.7% to 13.7%; sodium\u2013glucose cotransporter 2 inhibitors increased from 3.9% to 16.5%; angiotensin-converting enzyme inhibitors\/angiotensin-II receptor blockers increased from 28.1% to 43.0%; moderate-intensity statins increased from 61.6% to 70.5%; and aspirin increased from 23.7% to 32.9%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrated that T2DM patients with established or high risk of ASCVD might benefit from the use of evidence-based cardiovascular preventive medications with respect to the risk of 3-P MACE, HHF, and end-stage kidney disease or doubling of the serum creatinine level. Despite a modest annual increase in the use of evidence-based cardiovascular preventive medications in T2DM individuals with established or high risk of ASCVD, multiple strategies are needed to overcome barriers to the implementation of evidence-based therapies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1637035","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:13:45Z","timestamp":1757909625000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness and use of evidence-based cardiovascular preventive therapies in type 2 diabetes patients with established or high risk of atherosclerotic cardiovascular disease"],"prefix":"10.3389","volume":"16","author":[{"given":"Jian-Qing","family":"Tian","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi-Jun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Ting","family":"Peng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia-Wen","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi-Yi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Hao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2021.154838","article-title":"Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes","volume":"123","author":"Yun","year":"2021","journal-title":"Metabolism"},{"key":"B2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s12933-018-0728-6","article-title":"Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017","volume":"17","author":"Einarson","year":"2018","journal-title":"Cardiovasc Diabetol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1773","article-title":"Long-term absolute risk for cardiovascular disease stratified by fasting glucose level","volume":"42","author":"Bancks","year":"2019","journal-title":"Diabetes Care"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00536-5","article-title":"SGLT2 inhibitors and GLP-1 receptor agonists: established and emerging indications","volume":"398","author":"Brown","year":"2021","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(21)00203-5","article-title":"Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials","volume":"9","author":"Sattar","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)31149-3","article-title":"Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial","volume":"394","author":"Gerstein","year":"2019","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1901118","article-title":"Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"381","author":"Husain","year":"2019","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1607141","article-title":"Semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603827","article-title":"Liraglutide and cardiovascular outcomes in type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611925","article-title":"Canagliflozin and cardiovascular and renal events in type 2 diabetes","volume":"377","author":"Neal","year":"2017","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1812389","article-title":"Dapagliflozin and cardiovascular outcomes in type 2 diabetes","volume":"380","author":"Wiviott","year":"2019","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504720","article-title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes","volume":"373","author":"Zinman","year":"2015","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001040","article-title":"Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: A scientific statement from the American Heart Association","volume":"145","author":"Joseph","year":"2022","journal-title":"Circulation"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur Heart J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1002\/ejhf.2450","article-title":"Effects of sacubitril\/valsartan versus valsartan on renal function in patients with and without diabetes and heart failure with preserved ejection fraction: insights from PARAGON-HF","volume":"24","author":"Peikert","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"B16","doi-asserted-by":"publisher","first-page":"S207","DOI":"10.2337\/dc25-S010","article-title":"Cardiovascular disease and risk management: standards of care in diabetes-2025","volume":"48","year":"2025","journal-title":"Diabetes Care"},{"key":"B17","first-page":"315","article-title":"Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)","volume":"13","author":"Society.","year":"2021","journal-title":"Chin J Diabetes Mellitus"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.119.041730","article-title":"Use of guideline-recommended risk reduction strategies among patients with diabetes and atherosclerotic cardiovascular disease","volume":"140","author":"Arnold","year":"2019","journal-title":"Circulation"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e2148030","DOI":"10.1001\/jamanetworkopen.2021.48030","article-title":"Use of lipid-, blood pressure-, and glucose-lowering pharmacotherapy in patients with type 2 diabetes and atherosclerotic cardiovascular disease","volume":"5","author":"Nelson","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-023-02115-x","article-title":"AWARE A novel web application to rapidly assess cardiovascular risk in type 2 diabetes mellitus","volume":"60","author":"Berra","year":"2023","journal-title":"Acta Diabetol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2024.107517","article-title":"Improved glycemic and weight control with Dulaglutide addition in SGLT2 inhibitor treated obese type 2 diabetic patients at high cardiovascular risk in a real-world setting. The AWARE-2 study","volume":"210","author":"Berra","year":"2024","journal-title":"Pharmacol Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"S181","DOI":"10.2337\/dc25-S009","article-title":"Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2025","volume":"48","year":"2025","journal-title":"Diabetes Care"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.2478\/jtim-2024-0014","article-title":"Chinese expert consensus on blood lipid management in patients with diabetes (2024 edition)","volume":"12","author":"Xiao","year":"2024","journal-title":"J Transl Int Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800256","article-title":"Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes","volume":"379","author":"Rawshani","year":"2018","journal-title":"N Engl J Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-024-01115-w","article-title":"Atherosclerosis in diabetes mellitus: novel mechanisms and mechanism-based therapeutic approaches","volume":"22","author":"Khan","year":"2025","journal-title":"Nat Rev Cardiol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(19)30249-9","article-title":"Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials","volume":"7","author":"Kristensen","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)32590-x","article-title":"SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials","volume":"393","author":"Zelniker","year":"2019","journal-title":"Lancet"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(22)00172-3","article-title":"Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis","volume":"10","author":"Nazarzadeh","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2024.04.015","article-title":"Statin therapy and cardiovascular protection in type 2 diabetes: The role of baseline LDL-Cholesterol levels. A systematic review and meta-analysis of observational studies","volume":"34","author":"Soroush","year":"2024","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s12933-019-0875-4","article-title":"Aspirin has potential benefits for primary prevention of cardiovascular outcomes in diabetes: updated literature-based and individual participant data meta-analyses of randomized controlled trials","volume":"18","author":"Seidu","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s13098-025-01635-6","article-title":"Safety, efficacy, and cardiovascular benefits of combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists in patients with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Mousavi","year":"2025","journal-title":"Diabetol Metab Syndr"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000766","article-title":"Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: A scientific statement from the American Heart Association","volume":"141","author":"Arnold","year":"2020","journal-title":"Circulation"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-1481","article-title":"Changes in statin use among U.S. Adults with diabetes: A population-based analysis of NHANES 2011-2018","volume":"43","author":"Leino","year":"2020","journal-title":"Diabetes Care"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2024-004431","article-title":"Recent trends in GLP-1 RA and SGLT2i use among people with type 2 diabetes and atherosclerotic cardiovascular disease in the USA","volume":"12","author":"King","year":"2024","journal-title":"BMJ Open Diabetes Res Care"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2024.10.007","article-title":"Trends in type 2 diabetes medication use and guideline adherence in Belgian primary care (2019-2023)","volume":"19","author":"Raat","year":"2024","journal-title":"Prim Care Diabetes"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.05.057","article-title":"Prescription patterns for sodium-glucose cotransporter 2 inhibitors in U.S. Health systems","volume":"84","author":"Shin","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.118.038868","article-title":"Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus","volume":"139","author":"Zelniker","year":"2019","journal-title":"Circulation"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2025.107635","article-title":"Pharmacological regression of atherosclerotic plaque in patients with type 2 diabetes","volume":"213","author":"Bucciarelli","year":"2025","journal-title":"Pharmacol Res"},{"key":"B39","doi-asserted-by":"publisher","first-page":"S103","DOI":"10.2337\/dc19-S010","article-title":"Cardiovascular disease and risk management: standards of medical care in diabetes-2019","volume":"42","year":"2019","journal-title":"Diabetes Care"},{"key":"B40","doi-asserted-by":"publisher","first-page":"S140","DOI":"10.2337\/dc23-S009","article-title":"Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.08.014","article-title":"Therapeutic inertia in cardiovascular disease prevention: time to move the bar","volume":"74","author":"Dixon","year":"2019","journal-title":"J Am Coll Cardiol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1637035\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:13:47Z","timestamp":1757909627000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1637035\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":41,"alternative-id":["10.3389\/fendo.2025.1637035"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1637035","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,15]]},"article-number":"1637035"}}