Pharmacologic strategies to reduce cardiovascular disease in type 2 diabetes mellitus: focus on SGLT-2 inhibitors and GLP-1 receptor agonists

A. Bonaventura, S. Carbone, D. L. Dixon, A. Abbate, F. Montecucco

Research output: Contribution to journalReview article

Abstract

Patients with type 2 diabetes mellitus (T2D) present an increased risk for cardiovascular (CV) complications. In addition to improvement in glycaemic control, glucose-lowering therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-dependent glucose cotransporter (SGLT)-2 inhibitors, have been shown to significantly reduce CV events. In 2008, the US Food and Drug Administration mandated that all new glucose-lowering drugs undergo CV outcomes trials (CVOTs) to determine their CV safety. These trials have largely demonstrated no major CV safety concerns. Most notably, the GLP-1RAs and SGLT-2 inhibitors have been found to be not only safe, but also cardioprotective compared to placebo. The SGLT-2 inhibitors have opened a new perspective for clinicians treating patients with T2D and established CV disease in light of their ‘pleiotropic’ effects, specifically on heart failure, while GLP-1RAs seem to present more favourable effects on atherosclerotic events. In this review, we discuss the role of GLP-1RAs and SGLT-2 inhibitors to reduce CV risk in T2D patients and suggest an individualized therapeutic approach in this population based on the presence of metabolic and CV comorbidities.

Original languageEnglish
Pages (from-to)16-31
Number of pages16
JournalJournal of Internal Medicine
Volume286
Issue number1
DOIs
Publication statusPublished - Jul 2019

Keywords

  • anti-diabetic drugs
  • CV disease
  • diabetes
  • GLP-1 receptor agonists
  • heart failure
  • SGLT-2 inhibitors

ASJC Scopus subject areas

  • Internal Medicine

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