GLP-1 Receptor Agonists and Coronary Arteries: From Mechanisms to Events.

Aurélie Pahud De Mortanges,Arjola Bano,Eldem Sinaci,Matthias Wilhelm,Lia Bally,Taulant Muka,Dante Salvador

doi:10.3389/fphar.2022.856111

Aurélie Pahud De Mortanges, Arjola Bano + Show 5 more

Open Access

https://doi.org/10.3389/fphar.2022.856111

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Abstract

Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) lower plasma glucose through effects on insulin and glucagon secretion and by decelerating gastric emptying. GLP-1 RAs have many beneficial effects beyond glycemic control, including a protective role on the cardiovascular system. However, underlying mechanisms linking GLP-1 RAs with coronary artery disease are complex and not fully elucidated. In this mini-review, we discuss these mechanisms and subsequent clinical events. Data Sources: We searched PubMed and Google Scholar for evidence on GLP-1 RAs and coronary events. We did not apply restrictions on article type. We reviewed publications for clinical relevance. Synopsis of Content: In the first part, we review the current evidence concerning the role of GLP-1 RAs on potential mechanisms underlying the development of coronary events. Specifically, we discuss the role of GLP-1 RAs on atherosclerosis and vasospasms of epicardial coronary arteries, as well as structural/functional changes of coronary microvasculature. In the second part, we summarize the clinical evidence on the impact of GLP-1 RAs in the prevention of acute and chronic coronary syndromes and coronary revascularization. We conclude by discussing existing gaps in the literature and proposing directions for future research.

Highlights

Acute coronary syndromes (ACS), such as unstable angina pectoris, non-ST-elevated myocardial infarction (NSTEMI), and ST-elevated myocardial infarction (STEMI), and chronic coronary syndromes (CCS) replacing the term “stable angina” in 2019 ESC guidelines, are prevalent conditions with major contributions to morbidity and mortality (Neumann et al, 2020; Collet et al, 2021; Kurdi, 2021)
Recent reviews have described the role of GLP-1 RAs on cardiovascular risk in general, there is a lack of evidence synthesis on local actions of GLP-1 RAs in coronary arteries and the link of these mechanisms to coronary events (Garg et al, 2019; Heuvelman et al, 2020)
We focused on these processes because they are crucial to the development of coronary events, including ACS and CCS and vasospastic angina and microvascular angina (MVA) (Figure 1)

Summary

Introduction

Acute coronary syndromes (ACS), such as unstable angina pectoris (uAP), non-ST-elevated myocardial infarction (NSTEMI), and ST-elevated myocardial infarction (STEMI), and chronic coronary syndromes (CCS) replacing the term “stable angina” in 2019 ESC guidelines, are prevalent conditions with major contributions to morbidity and mortality (Neumann et al, 2020; Collet et al, 2021; Kurdi, 2021). Recent reviews have described the role of GLP-1 RAs on cardiovascular risk in general, there is a lack of evidence synthesis on local actions of GLP-1 RAs in coronary arteries and the link of these mechanisms to coronary events (Garg et al, 2019; Heuvelman et al, 2020). In this narrative mini-review, we discuss the association of GLP-1 RAs with atherosclerosis and vasospasm of epicardial coronary arteries, as well as structural/functional changes of coronary microcirculation. We provide an overview on GLP-1 RAs and the risk of coronary events

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Conclusion