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GLP-1RA and SGLT2i: Cardiovascular Impact on Diabetic Patients

Author(s):

Aschner Pablo, Blanc Evelyn, Folino Claudia and Morosán Allo Yanina*   Pages 1 - 10 ( 10 )

Abstract:


Background: Diabetes is a chronic disease, with high complexity, that demands strategic medical care with multifactorial risk-reduction approach. Over the past decade, the treatment of type 2 diabetes mellitus (T2DM) has entirely changed. One of the paradigm changes has been the arrival of new drugs that reduce the cardiovascular risk beyond the reduction of A1C.

Objective: Sodium-glucose cotransporter 2 (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) are two groups of antidiabetics drugs, which have demonstrated superiority compared to placebo for major cardiovascular events (MACE).

Methods: We update and discuss their impact on MACE expressed as relative risk (HR hazard ratio) and as the number needed to treat (NNT) to avoid one cardiovascular event in 5 years. We include the publications of the last 10 years.

Results: Empagliflozin, Canagliflozin and Dapagliflozin presents a HR for MACE of 0.86; 0.86; 0.86 and a NNT 38; 44; 33 respectively (Dapagliflozin in secondary prevention). Regarding HHF (Hospitalization for Heart Failure) the HR was 0.65; 0.67; 0.73 and a NNT of 44; 62; 98. Lixisenatide, Exenatide, Liragutide, Semaglutide, Albiglutide and Dulaglutide presented for MACE a HR of 1.02; 0.91; 0.87; 0.74; 0.78; 0.88 respectively. There was no increase in the risk of HHF, but there was no benefit either.

Conclusion: Cardiovascular benefits of the GLP-1RA and the SGLT2i are clinically significant. A number needed to treat under 50 is required to avoid one MACE in five years. These benefits have led to important changes in the Clinical Practice Guidelines and in the care of our patients with T2DM.

Keywords:

Cardiovascular outcomes, glucose lowering medications, type 2 diabetes mellitus, SGLT2i, GLP1 agonist, cardiovascular mechanisms, cardiovascular disease

Affiliation:

Javeriana University School of Medicine and San Ignacio University Hospital, Bogotá, Diabetes and Metabolism department, Favaloro Foundation, University Hospital, Buenos Aires, Diabetes and Metabolism department, Favaloro Foundation, University Hospital, Buenos Aires, Diabetes and Metabolism department, Favaloro Foundation, University Hospital, Buenos Aires



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