Commentary: Glucose control: Not just a bystander in GLP-1RA-mediated cardiovascular protection

Cardiovascular (CV) disease prevention in type 2 diabetes (T2D)demands multifactorial interventions including treatment of dyslipidemia, hypertension, hypercoagulability, and certainly hyperglycemia[1]. However, randomized controlled trials specifically addressing the impact of intensive glucose control (IGC) on CV outcomes yielded ambiguous results [2], while real-life evidence from a Swedish nationwide registry showed hyperglycemia as the strongest predictor of myocardial infarction (MI) and stroke [3]. Although CV outcome trials (CVOT) with GLP-1 receptor agonists (GLP-1RA) were designed to achieve glycemic equipoise, all showed a greater HbA1c reduction in the intervention arm [4–10], allowing to consider the potential effect of different degrees of glucose-lowering on their result