How Can We Increase the Utilization of Evidence-Based Medication After Myocardial Infarction?

Patients with diabetes are at increased risk of a variety of adverse events, including events that are ischemic and renal in nature as well as heart failure. Evidence-based therapies have been shown to<br />improve outcomes in this high-risk cohort. Long-term, intensive antiplatelet therapy reduces ischemic events. Lipid-lowering therapies, such as statins, PCSK9 inhibitors, and ezetimibe, also reduce ischemic events, includingmyocardial infarction. Glucagon-like peptide 1 receptor agonists (GLP1-RAs) work through metabolic pathways and have been shown to reduce mortality and ischemic events while improving quality of life. Heart failure and progression of kidney disease can be reduced with sodium-glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists. Due to their overall higher rates of events, patients with diabetes often have a greater benefit, when measured by the number of patients that need to be treated to prevent a single event, from current secondary prevention therapies. As a result, high-risk patients with diabetes, particularly those following amyocardial infarction, may derive a particular benefit from receiving a multidrug treatment strategy designed to target these different pathways to reduce overall risk.