Hitting the Sweet Spot: A Review of SGLT2i in Cardiovascular Medicine.

Glucagon-like peptide1 receptor agonists (GLP-1RAs) have emerged as a transformative class of therapies initially developed for glycemic control in type2 diabetes mellitus. Now, they are also getting recognized for their broader cardiometabolic effects. In this review, we discuss the mechanism of action of GLP-1RAs, focusing on their proposed cardiometabolic impact and the key clinical trials that have demonstrated improvement in cardiovascular outcomes. GLP-1RAs have demonstrated benefits in coronary artery disease, heart failure, blood pressure, and atrial fibrillation irrespective of type2 diabetes mellitus status, with new possible applications in peripheral arterial disease. Findings thus far have been translated into recommendations in clinical guidelines by the American College of Cardiology, American Heart Association, European Society of Cardiology, and American Diabetes Association. As GLP-1RAs become more prevalent in treating diabetes and patients with cardiovascular disease (CVD) or risk factors for CVD, clinicians will ultimately manage the practical aspects of patient selection, dosing, special considerations, and side effects of these medications. Ongoing and future clinical trials are expected to further define the cardiovascular role of GLP-1RAs, expand their therapeutic indications, and solidify their place in the evolving landscape of cardiovascular care.

Late-Breaking Science Abstracts From the American Heart Association's Scientific Sessions 2018 and Late-Breaking Abstracts in Resuscitation Science From the Resuscitation Science Symposium 2018.

Sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like-peptide-1 receptor (GLP-1-R) agonists are novel therapeutic agents used for the management of type 2 diabetes mellitus (T2DM). Recently, large-scale randomized clinical trials have been conducted to assess the cardiovascular safety of these medications. The findings of these trials have revealed that both SGLT2 inhibitors and GLP-1-R agonists exhibit favorable cardioprotective effects, including reduction in cardiovascular and all-cause mortality, a decreased risk of chronic kidney disease progression, a decrease in hospitalization for heart failure (HF), an effect shown by SGLT2 inhibitors, and stroke prevention, an effect shown by GLP-1-R agonists. Based on the results from above studies, the European and American Diabetes Associations have issued new recommendations strongly endorsing the use of SGLT2 inhibitors and GLP-1-R agonists in combination with metformin for patients with T2DM who have additional cardiovascular (CV) comorbidities or risk factors. The primary aim of this combined therapy is to prevent CV events. Although both medication groups offer beneficial effects, they demonstrate slightly different profiles. SGLT2 inhibitors have exhibited better effects regarding a reduced incidence of HF, whereas GLP-1-R agonists have shown a reduced risk of CV events, particularly stroke. Moreover, recent European Society of Cardiology as well as American College of Cardiology and American Heart Association guidelines of HF treatment stressed the importance of SGLT2 inhibitor administration in patients with HF regardless of T2DM. In this context, we present and discuss the outcomes of the most recent trials investigating the impact of SGLT2 inhibitors and GLP-1-R agonists on renal and cardiovascular outcomes in patients, both with and without T2DM. Additionally, we explore the synergistic effects of combining SGLT2 inhibitors and GLP-1-R agonists in patients with cardiovascular disease.

Sodium-glucose co-transporter 2 inhibitors for heart failure: clinical trial efficacy and clinical practice effectiveness.

Cardiovascular and renal complications remain leading causes of morbidity and mortality among individuals with type 2 diabetes mellitus (T2DM). Since 2015, large-scale cardiovascular outcome trials (CVOTs) have demonstrated that sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) significantly reduce the risk of major adverse cardiovascular events, cardiovascular mortality, and heart failure hospitalization in patients with T2DM and established cardiovascular disease or high-risk profiles. These findings—originating from landmark trials such as EMPA-REG OUTCOME, LEADER, and SUSTAIN-6—have led to substantial revisions in international guidelines from the European Society of Cardiology, American College of Cardiology, and American Heart Association, which now recommend the use of SGLT2i or GLP-1 RAs, often in conjunction with metformin. SGLT2i have shown robust effects in reducing heart failure hospitalization and slowing the progression of chronic kidney disease, while GLP-1 RAs have demonstrated superior efficacy in reducing atherothrombotic events, particularly non-fatal stroke. Additionally, emerging data supports the complementary use of both drug classes, revealing additive benefits on cardiovascular and renal outcomes without increased toxicity. This narrative review summarizes the mechanisms of action, clinical efficacy, safety profiles, and sex-specific outcomes associated with SGLT2i and GLP-1 RAs. It also highlights key evidence supporting their combined use and underscores their critical role in optimizing long-term outcomes in patients with T2DM and cardiovascular disease.

Randomized Trials Fit for the 21st Century: A Joint Opinion From the European Society of Cardiology, American Heart Association, American College of Cardiology, and the World Heart Federation.

European guidelines on cardiovascular disease prevention in clinical practice<SBT>Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts)

The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology.

Infective endocarditis: Perioperative management and surgical principles

Two pharmacological principles, one at least 80 years old and another over 60 years old have recently come to fruition. The first, phlorizin, was thought to cause diabetes, but then a closer look revealed a renal mechanism that was independent of insulin or insulin deficiency. Research into its action facilitated the discovery of sodium-dependent glucose transporters. The second compound came close on the heels of the discovery that the mineralocorticoid, aldosterone, can be released through the action of angiotensin II.

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease with significant cardiovascular (CV) implications. The management of diabetes plays a crucial role in reducing the risk of cardiovascular disease (CVD) and improving patient outcomes. This review examines the impact of various therapeutic strategies and their relevance to specific demographic groups, particularly the elderly and those with chronic kidney disease (CKD). Methods: A comprehensive literature review was conducted focusing on randomized controlled trials (RCTs), meta-analyses, systematic reviews, and large observational studies from PubMed, Cochrane Library, and Google Scholar. Results: Metformin and sodium-glucose cotransporter-2 (SGLT2) inhibitors consistently reduced CV mortality by 20–38% compared to other treatments. Incretin-based therapies like liraglutide and semaglutide reduced major adverse cardiovascular events (MACE) by 13–26%. Lifestyle interventions lowered CV risk when combined with medications. SGLT2 inhibitors conferred renal and CV protection in patients with CKD. Bariatric surgery (BS) has been associated with significant improvements in CV outcomes. Conclusion: Metformin, SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), BS, and lifestyle modification conferred CV benefits. Management of type 2 diabetes with a view to reducing CV risk requires an individualized approach, taking into account patient characteristics, comorbidities, and the CV risk profiles of various treatment options.

2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure

2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices.

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary