2022 Canadian Cardiovascular Society Guideline for Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors for Cardiorenal Risk Reduction in Adults Journal Articles uri icon

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  • This guideline synthesizes clinical trial data supporting the role of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors (SGLT2i) for treatment of heart failure (HF), chronic kidney disease, and for optimizing prevention of cardiorenal morbidity and mortality in patients with type 2 diabetes. It is on the basis of a companion systematic review and meta-analysis guided by a focused set of population, intervention, control, and outcomes (PICO) questions that address priority cardiorenal end points. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system and a modified Delphi process were used. We encourage comprehensive assessment of cardiovascular (CV) patients with routine measurement of estimated glomerular filtration rate, urinary albumin-creatinine ratio, glycosylated hemoglobin (A1c), and documentation of left ventricular ejection fraction (LVEF) when evaluating symptoms of HF. For patients with HF, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy for the reduction of hospitalization for HF when LVEF is > 40% and for the reduction of all-cause and CV mortality, hospitalization for HF, and renal protection when LVEF is ≤ 40%. In patients with albuminuric chronic kidney disease, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy to reduce all-cause and CV mortality, nonfatal myocardial infarction, and hospitalization for HF. We provide recommendations and algorithms for the selection of glucagon-like peptide-1 receptor agonists and SGLT2i for patients with type 2 diabetes and either established atherosclerotic CV disease or risk factors for atherosclerotic CV disease to reduce all-cause and CV mortality, nonfatal stroke, and for the prevention of hospitalization for HF and decline in renal function. We offer practical advice for safe use of these diabetes-associated agents with profound cardiorenal benefits.


  • Mancini, GB John
  • O’Meara, Eileen
  • Zieroth, Shelley
  • Bernier, Mathieu
  • Cheng, Alice YY
  • Cherney, David ZI
  • Connelly, Kim A
  • Ezekowitz, Justin
  • Goldenberg, Ronald M
  • Leiter, Lawrence A
  • Nesrallah, Gihad
  • Paty, Breay W
  • Piché, Marie-Eve
  • Senior, Peter
  • Sharma, Abhinav
  • Verma, Subodh
  • Woo, Vincent
  • Darras, Pol
  • Gabor, Jonathan Y
  • Grégoire, Jean
  • Lonn, Eva
  • Stone, James A
  • Yale, Jean-François
  • Yeung, Colin
  • Zimmerman, Deborah

publication date

  • August 2022

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