Mechanistic insights regarding the role of SGLT2 inhibitors and GLP1 agonist drugs on cardiovascular disease in diabetes
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The treatment landscape for patients with established or at high risk for cardiovascular disease and type 2 diabetes mellitus has entirely changed over the past decade, with the introduction of several anti-hyperglycemic agents. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are two anti-hyperglycemic classes which have been of special interest after multiple large cardiovascular disease (CVD) outcomes studies have demonstrated superiority of these agents compared to placebo for major adverse CVD events and in some cases, hospitalization for heart failure. Despite the dramatic results of these trials, only recently have we began to understand the mechanisms underlying these CVD benefits. Here we review the underlying mechanisms which have the greatest plausibility for both of these agents including the impact of ventricular loading conditions, direct effects on cardiac structure and function, myocardial energetics and sodium/hydrogen exchange for SGLT2 inhibitors, and the anti-atherosclerotic, anti-inflammatory, and modulation of endothelial function for GLP-1 agonists.
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GLP-1RAs are predominantly associated with decreased atherosclerosis-mediated events, whereas SGLT2 inhibitors are predominantly associated with heart failure and chronic kidney disease outcomes.
“Specifically, GLP-1RAs are predominantly associated with decreased atherosclerosis-mediated events, whereas SGLT2 inhibitors are predominantly associated with HF and CKD outcomes.38”
From Use of Glucagon-Like Peptide-1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Review (2020) · cites this paper as [38]
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- Authors
- Garg, V., Verma, S., & Connelly, K.
- Affiliations
- St. Michael's Hospital (CA)
- Corresponding author
- Connelly, Kim
- Venue
- Progress in Cardiovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 62
- Issue
- 4
- Pages
- 349-357
- ISSN
- 0033-0620 (ISSN-L)
- OpenAlex
- W2965687553
- Cited by
- 82
- References
- 88
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 11 · 2021: 19 · 2020: 23 · 2019: 2
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Progress in Cardiovascular Diseases (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Amgen
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- Valeant Pharmaceuticals International
- Bayer HealthCare
- Novo Nordisk
- Servier
- Canadian Institutes of Health Research
- Ontario Ministry of Research and Innovation
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- SGLT2 inhibitors, GLP-1 receptor agonists, type 2 diabetes, cardiovascular disease, major adverse cardiovascular events, heart failure hospitalization, anti-hyperglycemic agents, ventricular loading, cardiac structure and function, myocardial energetics, Na+/H+ exchange, atherosclerosis, inflammation, endothelial function
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Aged, Cardiovascular Diseases, Cardiovascular System, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Male, Middle Aged, Severity of Illness Index, Prevalence, Risk Assessment, Glucagon-Like Peptide 1
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