Abstract
Metabolic diseases and diabetes represent an increasing global challenge for human health care. As associated with a strongly elevated risk of developing atherosclerosis, kidney failure and death from myocardial infarction or stroke, the treatment of diabetes requires a more effective approach than lowering blood glucose levels. This review summarizes the evidence for the cardioprotective benefits induced by antidiabetic agents, including sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP1-RA), along with sometimes conversely discussed effects of dipeptidyl peptidase-4 inhibitor (DPP4i) and metformin in patients with high cardiovascular risk with or without type 2 diabetes. Moreover, the proposed mechanisms of the different drugs are described based on the results of preclinical studies. Recent cardiovascular outcome trials unexpectedly confirmed a beneficial effect of GLP-1RA and SGLT2i in type 2 diabetes patients with high cardiovascular risk and with standard care, which was independent of glycaemic control. These results triggered a plethora of studies to clarify the underlying mechanisms and the relevance of these effects. Taken together, the available data strongly highlight the potential of repurposing the original antidiabetics GLP1-RA and SGLT2i to improve cardiovascular outcome even in non-diabetic patients with cardiovascular diseases.
Highlights
With the global health problem of overweight and obesity, the prevalence of type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD) is drastically increasing
We summarize the results from clinical studies evaluating the cardioprotective potential of glucose-lowering drugs including metformin, dipeptidyl peptidase-4 inhibitor (DPP4i), glucagon-like peptide-1 receptor agonist (GLP1-RA), and sodium-glucose cotransporter 2 inhibitor (SGLT2i)
Lowering of HbA1c was initially observed after 3 months, but no differences were remaining 12 months after treatment (Petrie et al, 2017). These findings indicate a use of metformin to improve CVD risk management in both T1D and T2D, but do not support a beneficial effect on glycaemic control in T1D patients
Summary
With the global health problem of overweight and obesity, the prevalence of type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD) is drastically increasing. While broad evidences confirm the safety of glucose-lowering agents from these classes except saxagliptin, several clinical trials strongly indicate drug-specific, beneficial effects of SGLT2i and GLP1-RA on cardiovascular outcome in T2D patients with high cardiovascular risk.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
