Estimation of efficiency and safety of use SGLT2 inhibitors and glucagon-like peptide agonists among patients with diabetes and cardiovascular disease in clinical practice

: Patients with diabetes continued to exhibit a high risk for cardiovascular and renal events despite achieving satisfactory glycemic, blood pressure and lipid targets. Studies evaluating new diabetes medications focused on cardiovascular events, largely overlooking heart failure (HF). The latter has recently been recognised as a major cause of morbidity and mortality in patients with diabetes mellitus. There had been an unmet need for drugs with cardiovascular (including HF) and renal protection, with an expectation that an ideal diabetic drug should improve these end points. Moreover, an ideal drug should have weight lowering benefits. Recently published outcome trials have shown that sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs) can reduce cardiovascular and renal events, together with statistically significant weight reduction. As a result, many recently published international guidelines have recommended SGLT2 inhibitors and GLP-1RAs in patients with diabetes and pre-existing cardiovascular disease (CVD). In this review we will critically analyse the efficacy and cardiovascular (CV) safety of SGLT2 inhibitors, based on the available literature to help position them in the clinical decision process.

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Cardiovascular disease risk reduction in patients with diabetes - is clinical practice effective?

Practical Diabetes International ◽

10.1002/1528-252x(200007/08)17:5<155::aid-pdi56>3.0.co;2-a ◽

2000 ◽

Vol 17 (5) ◽

pp. 155-158 ◽

Cited By ~ 2

Author(s):

M.G. Masding ◽

F.M. Martch ◽

D.H. Cove

Keyword(s):

Cardiovascular Disease ◽

Clinical Practice ◽

Risk Reduction ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Patients With Diabetes

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SGLT-2 Inhibitors and GLP-1 Agonists: First-Line Therapy for Diabetes With Established Cardiovascular Disease

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248419838511 ◽

2019 ◽

Vol 24 (5) ◽

pp. 422-427 ◽

Cited By ~ 4

Author(s):

Aparna P. Sajja ◽

Amit K. Dey ◽

Avirup Guha ◽

Youssef Elnabawi ◽

Aditya A. Joshi ◽

...

Keyword(s):

Cardiovascular Disease ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Growing Body ◽

Patients With Diabetes ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

Sodium Glucose Cotransport

There is a growing body of evidence that diabetes represents a significant and largely modifiable risk factor for cardiovascular disease (CVD). It is known to markedly increase the risk of CVD—with CVD accounting for 2 of every 3 deaths in patients with diabetes. It is suggested that once patients with diabetes develop clinical coronary disease, they have a grim prognosis. In 2008, the Food and Drug Association mandated the evidence of CV safety in any new diabetic therapy, leading to a multitude of large CV outcome trials to assess CV risk from these medications. However, several of these outcome trials with novel antidiabetic therapies have demonstrated not only safety but a clear and definite CV advantage in patients with type 2 diabetes. In this review, we discuss 2 relatively newer classes of diabetic drugs, sodium glucose cotransport 2 inhibitors and glucagon-like peptide 1 agonists, evaluate their efficacy in improving CV outcomes, and discuss the future of CV prevention with these agents.

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Glucose-lowering therapies in patients with type 2 diabetes and cardiovascular diseases

European Journal of Preventive Cardiology ◽

10.1177/2047487319880040 ◽

2019 ◽

Vol 26 (2_suppl) ◽

pp. 73-80 ◽

Cited By ~ 18

Author(s):

Francesco Prattichizzo ◽

Lucia La Sala ◽

Lars Rydén ◽

Nikolaus Marx ◽

Marc Ferrini ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Receptor Agonist ◽

Glucose Lowering ◽

Patients With Diabetes ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

Type 2 diabetes mellitus is a major risk factor for developing cardiovascular disease, and many patients with diabetes have prevalent cardiovascular complications. Recent cardiovascular outcome clinical trials suggest that certain new glucose-lowering drugs are accompanied by additional cardioprotective properties. Indeed, selected glucagon-like peptide-1 receptor agonists have a proved cardiovascular benefit in terms of a reduced incidence of ischaemic events, while sodium/glucose co-transporter-2 inhibitors have also shown significant protection, with a striking effect on heart failure and renal endpoints. These findings have been integrated in recent guidelines which now recommend prescribing (when initial metformin monotherapy fails) a glucagon-like peptide-1 receptor agonist or a sodium/glucose co-transporter-2 inhibitor with clinical trial-confirmed benefit in patients with diabetes and atherosclerotic cardiovascular disease, and a sodium/glucose co-transporter-2 inhibitor in such patients with heart failure or chronic kidney disease at initial stages. Furthermore, the new 2019 European Society of Cardiology guidelines in collaboration with the European Association for the Study of Diabetes recommend a glucagon-like peptide-1 receptor agonist or a sodium/glucose co-transporter-2 inhibitor in treatment-naive patients with type 2 diabetes mellitus with pre-existing cardiovascular disease or at high cardiovascular risk. Future research will disentangle the mechanisms underpinning these beneficial effects and will also establish to what extent these results are generalisable to the whole diabetes population. In the meantime, available evidence should prompt a wide diffusion of these two classes of drugs among patients with diabetes and cardiovascular disease. Here, we briefly summarise recent findings emerging from cardiovascular outcome clinical trials, discuss their impact on treatment algorithms and propose new possible approaches to improve our knowledge further regarding the cardiovascular effect of glucose-lowering medications.

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