Fig. 1.

Proposed Clinical Algorithm. American College of Cardiology Expert Clinical Decision Pathway suggested algorithm for the initiation and use of SGLT2i or GLP1RA agents in patients with type 2 diabetes and established ASCVD. There is no agreed upon method for determining high ASCVD risk in the absence of established ASCVD for eligibility for these therapies. †Efficacy has been clearly demonstrated for patients with established ASCVD. However, high-risk primary prevention patients were eligible in the described GLP-1RA and SGLT2i trials if older than 50–60 years of age with multiple typical risk factors including tobacco use, hypertension, and dyslipidemia [26,37,38]. This is one approach to identify patients without established ASCVD for whom these therapies can be considered, although the use of GLP-1RA and SGLT2i therapies can ultimately be left to the discretion of the treating cardiovascular specialist. Adapted with permission [31]. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; DPP4, dipeptidyl peptidase-4; ESRD, end-stage renal disease; GLP-1RA, glucagon-like peptide-1 receptor agonist; PAD, peripheral artery disease; SGLT2 inhibitor, sodium-glucose cotransporter-2 inhibitor.