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Hypoglycemic Therapies and Reducing CVD Risk

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Handbook of Outpatient Cardiology

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Abstract

Certain hypoglycemic therapies including metformin, sodium glucose co-transporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 receptor (GLP-1R) agonists have emerged as important agents to reduce cardiovascular events in high-risk patients. To date, three GLP-1R agonists have demonstrated a reduction in major adverse cardiovascular events (MACE) among diabetic patients with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors: dulaglutide, liraglutide, and injectable semaglutide. Three SGLT2 inhibitors, canagliflozin, dapagliflozin, and empagliflozin, have been shown to reduce heart failure hospitalizations and cardiovascular (CV) mortality in patients with type 2 diabetes mellitus (T2DM) and ASCVD or ASCVD risk factors. Additionally, dapagliflozin and empagliflozin have been shown to reduce heart failure (HF) hospitalizations and CV mortality in heart failure with reduced ejection fraction (HFrEF) patients regardless of T2DM status. In the following chapter, we summarize the evidence for the cardiovascular benefits of hypoglycemic agents and outline indications, contraindications, and precautions of each drug class.

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Abbreviations

ADA:

American Diabetes Association

ASCVD:

Atherosclerotic cardiovascular disease

BMI:

Body mass index

CV:

Cardiovascular

DKA:

Diabetic ketoacidosis

DPP-4:

Dipeptidyl peptidase-4

ESRD:

End-stage renal disease

FDA:

Food and Drug Administration

GLP-1R:

Glucagon-like peptide-1 receptor

GFR:

Glomerular filtration rate

HF:

Heart failure

HFrEF:

Heart failure with reduced ejection fraction

MACE:

Major adverse cardiovascular events

MEN2:

Multiple endocrine neoplasia type 2

MI:

Myocardial infarction

NYHA:

New York Heart Association

SGLT2:

Sodium glucose co-transporter 2

T2DM:

Type 2 diabetes mellitus

UKPDS:

United Kingdom Prospective Diabetes Study

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Inbar Raber & Eli V. Gelfand

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  1. Inbar Raber
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  2. Eli V. Gelfand
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Correspondence to Inbar Raber .

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Editors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Ankit A. Bhargava

  2. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Bryan J. Wells

  3. Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Pablo A. Quintero

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Raber, I., Gelfand, E.V. (2022). Hypoglycemic Therapies and Reducing CVD Risk. In: Bhargava, A.A., Wells, B.J., Quintero, P.A. (eds) Handbook of Outpatient Cardiology . Springer, Cham. https://doi.org/10.1007/978-3-030-88953-1_12

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  • DOI: https://doi.org/10.1007/978-3-030-88953-1_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-88952-4

  • Online ISBN: 978-3-030-88953-1

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