Highlights
- •GLP-1 receptor agonists reduce atherosclerotic CVD and albuminuria.
- •SGLT-2 inhibitors have also shown benefits in heart failure and renal outcomes.
- •Glycemic control and cardiorenal prevention are both recommended in T2D management.
Abstract
Findings from cardiovascular outcome trials on certain newer glucose-lowering drugs
have shown clear cardiovascular and renal benefits. In this review, we provide an
updated overview of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium−glucose
cotransporter 2 (SGLT-2) inhibitors in terms of cardiovascular and renal protection.
Both drugs have been described as diabetes/disease-modifying drugs.
There is robust evidence on the benefits of GLP-1 receptor agonists in renal disease
and atherosclerotic cardiovascular disease—especially in stroke—which are mainly explained
by their antiproteinuric effect. However, this class of drugs has only shown neutral
effects on heart failure and further studies are necessary in order to assess their
role in this disease.
SGLT-2 inhibitors have shown strong benefits in heart failure hospitalizations and
renal outcomes, mainly through limiting glomerular filtration rate deterioration,
regardless of the presence of diabetes. Nonetheless, their effect on the prevention
of major adverse atherosclerotic cardiovascular events and cardiovascular mortality
seems to be limited to patients with type 2 diabetes and established cardiovascular
disease.
Evidence on the cardiovascular and renal benefits of GLP-1 receptor agonists and SGLT-2
inhibitors have significantly modified management plans and treatment choices for
patients with type 2 diabetes. There is now a focus on a multifactorial approach that
goes beyond the glucose-lowering effect of these drugs, which are the preferred choice
in routine clinical practice.
According to the current evidence, a patient-focused approach that includes both individualized
glycemic control and cardiorenal prevention using GLP-1 receptor agonists and SGLT-2
inhibitors with proven cardiovascular and renal benefits is believed to be the best
strategy for achieving the treatment goals of patients with type 2 diabetes. Despite
the strong cardiovascular and renal benefits of these drugs, further research is required
in order to clarify questions that remain unanswered.
Keywords
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Article info
Publication history
Published online: November 16, 2021
Accepted:
November 9,
2021
Received in revised form:
November 3,
2021
Received:
August 2,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
