What is it about?

Drug development has significantly evolved over the past decade, shifting focus from controlling hyperglycemia to prioritizing cardiovascular outcomes, particularly macrovascular event prevention, as real-world evidence has accumulated. This major shift happened after 2016, when several cardiovascular outcome trials (CVOTs) reported results for new antidiabetic drugs like Liraglutide and Empagliflozin. Since 2023, the field has entered the Cardio-Renal-Metabolic (CKM) syndrome era. With progress in lipid, proteinuria, and hypertension management, the focus extends beyond glucose control. Emerging data on new cardiovascular biomarkers and an increasing number of CVOTs have strengthened the idea of cardiorenal benefits. This review highlights key CVOTs from the last decade that have challenged the traditional view of cardiovascular safety in diabetes treatments.

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Why is it important?

The study examines the evolution of metabolic disorder management over the past decade. Advances in the concept of CKM treatment have enhanced the Endocrinologist's role in preventing early-onset CKM, and treatments and pharmacological therapies for controlling metabolic diseases such as dyslipidemia, hypertension, and hyperglycemia have improved. The importance of 3-hypers management and comprehensive risk management is increasingly recognized. In the coming decades, the cardiorenal metabolic era will deepen through the identification of new biomarkers for CKM and remnant CVD risks, and the development of personalized, precision-based treatments.

Perspectives

In the era of precision therapeutics, an endocrinologist's focus and treatment may extend beyond multi-risk alleviation, and interventions could be initiated earlier and personalized more, as we anticipate more paradigm-shifting and effective therapies entering clinics that benefit more patients.

Dr. Song Wen
Shanghai Pudong Hospital, Fudan University

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This page is a summary of: Cardiovascular outcome trials (CVOTs) in cardiorenal metabolic medicine: a decade of transformative progress (2016–2026), Cardiovascular Diabetology, April 2026, Springer Science + Business Media,
DOI: 10.1186/s12933-026-03164-6.
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