Abstract
Type 2 Diabetes Mellitus (T2DM) is associated with a high risk of atherosclerotic cardiovascular (CV) disease. Among the well-known pathophysiologic factors, crucial roles are played by endothelial dysfunction (caused by oxidative stress and inflammation hyperglycemia-linked), increased activity of nuclear factor kB, altered macrophage polarization, and reduced synthesis of resident endothelial progenitor cells. As consequence, a potentially rapid progression of the atherosclerotic disease with a higher propensity to unstable plaque is arguable, finally leading to significantly increased cardiovascular mortality. Main managements are focused on both prevention and early diagnosis, by targeted treatment of hyperglycemia and vascular complications. Innovative therapeutic approaches for T2DM seek to customize the antidiabetic treatment to each patient in order to optimize glucose-lowering effects, minimize hypoglycemia and adverse effects, and prevent cardiovascular events. The newer drugs (e.g., Glucagon Like Peptide-1 Receptor Agonists, GLP-1 RAs; Sodium GLucose coTransporter-2 inhibitors, SGLT2is; DiPeptidyl Peptidase-4 inhibitors, and DPP4is) impact body weight, lipid parameters, and blood pressure, as well as endothelial (dys)functions, inflammatory markers, biomarkers of both oxidative stress, and subclinical atherosclerosis. The present review summarizes the results of the main trials focused on the cardiovascular safety of these drugs from the CV standpoint.
Highlights
Cardiovascular disease (CVD) is the predominant cause of death in diabetic patients [1,2]
The main therapy that attenuating Diabetic kidney disease (DKD) was the renin-angiotensin system blockade through angiotensin-converting enzyme inhibitors (ACEi) or Angiotensin II Receptor Blocker (ARB) treatments. It has been suggested as second-line therapy in Type 2 Diabetes Mellitus (T2DM) patients the use of sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) for their reno-cardiovascular safety profile [1]
The EMPagliflozin compaRative effectIveness and SafEty (EMPRISE; CT. gov identifier: NCT03363464) study was aimed to assess empagliflozin’s effectiveness, safety, and healthcare utilization in routine care for five years. It investigated the risk of hospitalization for heart failure (HHF) among T2DM patients initiating empagliflozin vs. sitagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4i) [60] demonstrating that empagliflozin decreased the risk of HHF-specific by 50% and the risk of HHF-broad by 49%, independently of the doses of empagliflozin daily (10 mg or 25mg) for patients with and without baseline cardiovascular disease
Summary
Cardiovascular disease (CVD) is the predominant cause of death in diabetic patients [1,2]. Data resulted from recent clinical trials provide updated insightful information about the cardiovascular benefits of therapeutic approaches that are currently available These trials expanded our knowledge on the efficacy and safety of novel antidiabetic drugs shedding light on undesirable effects about specific aspects of cardiovascular (CV) risk. The main therapy that attenuating DKD was the renin-angiotensin system blockade through angiotensin-converting enzyme inhibitors (ACEi) or Angiotensin II Receptor Blocker (ARB) treatments It has been suggested as second-line therapy in T2DM patients the use of sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) for their reno-cardiovascular safety profile [1]. ↓ Extracellular volume little changes in High Density Lipoprotein-Cholesterol (HDL-C), triglyceride, and Low Density
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