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Pharmacologic strategies to reduce cardiovascular disease in type 2 diabetes mellitus: focus on SGLT ‐2 inhibitors and GLP ‐1 receptor agonists
Author(s) -
Bonaventura A.,
Carbone S.,
Dixon D. L.,
Abbate A.,
Montecucco F.
Publication year - 2019
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12890
Subject(s) - medicine , type 2 diabetes mellitus , diabetes mellitus , glucagon like peptide 1 receptor , type 2 diabetes , disease , receptor , pharmacology , agonist , endocrinology
Patients with type 2 diabetes mellitus (T2D) present an increased risk for cardiovascular ( CV ) complications. In addition to improvement in glycaemic control, glucose‐lowering therapies, such as glucagon‐like peptide‐1 receptor agonists ( GLP ‐1 RA s) and sodium‐dependent glucose cotransporter ( SGLT )‐2 inhibitors, have been shown to significantly reduce CV events. In 2008, the US Food and Drug Administration mandated that all new glucose‐lowering drugs undergo CV outcomes trials ( CVOT s) to determine their CV safety. These trials have largely demonstrated no major CV safety concerns. Most notably, the GLP ‐1 RA s and SGLT ‐2 inhibitors have been found to be not only safe, but also cardioprotective compared to placebo. The SGLT ‐2 inhibitors have opened a new perspective for clinicians treating patients with T2D and established CV disease in light of their ‘pleiotropic’ effects, specifically on heart failure, while GLP ‐1 RA s seem to present more favourable effects on atherosclerotic events. In this review, we discuss the role of GLP ‐1 RA s and SGLT ‐2 inhibitors to reduce CV risk in T2D patients and suggest an individualized therapeutic approach in this population based on the presence of metabolic and CV comorbidities.