Glycemic Management Strategies and Cardiovascular Event Risk in Elderly Patients with Diabetes and Cardiovascular Disease

This study employed a retrospective analysis combined with a prospective cohort design involving 480 elderly patients with diabetes and cardiovascular disease, followed over 18 months. It systematically evaluated the impact of insulin, GLP-1 receptor agonists, SGLT-2 inhibitors, and traditional oral hypoglycemic agents on cardiovascular event risk. Results showed that SGLT-2 inhibitors reduced cardiovascular event risk by 47% (HR=0.53, 95% CI 0.310.91, P<0.01). GLP-1 receptor agonists demonstrated dose-dependent cardioprotective effects (event rate of 11.2% in the 1.0 mg/week semaglutide group vs. 16.8% in the 0.5 mg/week group, P<0.05). While intensive insulin therapy reduced HbA1c to 7.6%, a linear association was observed between hypoglycemia and cardiovascular risk (each additional hypoglycemic event increased risk by 37%, P<0.01). The study emphasizes the need to stratify drug selection based on cardiovascular phenotypes (heart failure/coronary artery disease/stroke) and proposes a three-dimensional management framework integrating glycemic variabilityinflammationmyocardial metabolism, offering evidence-based support for precise clinical treatment.