Abstract
The risk of cardiovascular disease (CVD) (myocardial infarction, stroke, peripheral vascular disease) is twice in type 2 diabetes (T2D) patients compared to non-diabetic subjects. Furthermore, cardiovascular disease (CV) is the leading cause of death in patients with T2D.
In the last years several clinical intervention studies with new anti-hyperglycaemic drugs have been published, and they have shown a positive effect on the reduction of mortality and cardiovascular risk in T2D patients. In particular, these studies evaluated sodium/glucose-2 cotransporter inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP-1RA).
In secondary prevention, it was clearly demonstrated that SGLT2i and GLP-1RA drugs reduce CV events and mortality, and new guidelines consider now these drugs as first choice (after metformin) in the treatment of T2D; there are also some signs that they may be effective also in primary prevention of CVD. However, the mechanisms involved in cardiovascular protection are not yet fully understood, but they appear to be both “glycaemic” and “extra-glycaemic”.
In this review, we will examine the fundamental results of the clinical trials on SGLT2i and GLP-1RA, their clinical relevance in term of treatment of T2D, and we will discuss the mechanisms that may explain how these drugs exert their cardiovascular protective effects.
Keywords
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Editors and Affiliations
Glossary
Glossary
- ADA:
-
American Diabetes Association
- ANP:
-
atrial natriuretic peptide
- ARB:
-
angiotensin-receptor blocker
- ASCVD:
-
atherosclerotic cardiovascular disease
- CANVAS:
-
Canagliflozin Cardiovascular Assessment Study
- CKD:
-
chronic kidney disease
- CPCs:
-
cardiac progenitor cells
- CREDENCE:
-
Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation CV
cardiovascular
- CVD-Real 2:
-
Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium- Glucose Cotransporter-2 Inhibitors
- CVD:
-
cardiovascular disease
- DAPA-HF:
-
Dapagliflozin and Prevention of AdverseOutcomes in Heart Failure
- DECLARE-TIMI 58:
-
Dapagliflozin Effect on Cardiovascular Events
- DPP4-i:
-
dipeptidyl peptidase-4 inhibitors
- EASD:
-
European association for the study of Diabetes
- EASEL:
-
Evidence for Cardiovascular Outcomes With Sodium Glucose Cotransporter 2 Inhibitors in the Real World
- ELIXA:
-
Evaluation of Lixisenatide in Acute Coronary Syndrome
- EMPAREG:
-
The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose
- ESRD:
-
end-stage renal disease
- EXSCEL:
-
Exenatide Study of Cardiovascular Event Lowering Trial
- FDA:
-
Food and Drug Administration
- FFA:
-
free fatty acid
- GLP-1RA:
-
GLP-1 receptor agonists
- HARMONY:
-
Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease
- LEADER:
-
Liraglutide Effect and Action in Diabetes
Evaluation of Cardiovascular Outcome Results
- MACE:
-
Major Cardiovascular Events
- NAFLD:
-
non-alcoholic hepatic steatosis
- NYHA:
-
New York Heart Association
- PIONEER 6:
-
Peptide Innovation for Early Diabetes Treatment
- REWIND:
-
Researching Cardiovascular Events with a Weekly Incretin in Diabetes
- SGLT2i:
-
Sodium/glucose-2 cotransporter inhibitors
- STEMI:
-
ST-segment elevation myocardial infarction
- SUSTAIN:
-
Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes 6 (SUSTAIN-6)
- T2D:
-
type 2 diabetes
- UKPDS:
-
United Kingdom Prospective Diabetes Study
- VADT:
-
Veterans Affairs Diabetes Trial
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Bertoccini, L., Baroni, M.G. (2020). GLP-1 Receptor Agonists and SGLT2 Inhibitors for the Treatment of Type 2 Diabetes: New Insights and Opportunities for Cardiovascular Protection. In: Islam, M.S. (eds) Diabetes: from Research to Clinical Practice. Advances in Experimental Medicine and Biology(), vol 1307. Springer, Cham. https://doi.org/10.1007/5584_2020_494
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