Korean J Fam Pract.  2022 Apr;12(2):61-71. 10.21215/kjfp.2022.12.2.61.

Diabetes Medications and Cardiovascular Disease Prevention

Affiliations
  • 1Department of Family Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea

Abstract

Type 2 diabetes is a metabolic disease of the heart that affects both micro and macro blood vessels. Cardiovascular disease is the leading cause of death in diabetic patients. Some diabetes medications reduce microvascular complications such as retinopathy, nephropathy, and neuropathy. However, they have not reduced macrovascular complications, such as myocardial infarction or stroke. Therefore, this article intends to specifically review the results of recent cardiovascular disease-related clinical trials for diabetes drugs. Metformin is the primary drug with benefits for cardiovascular disease. Sulfonylureas did not show cardiovascular benefits. Rosiglitazone, a thiazolidinedione class, increased the risk of heart failure, while pioglitazone improved cardiovascular outcomes. Among the DPP-4 inhibitors, saxagliptin increased hospitalizations for heart failure by 27%. Other DPP-4 inhibitors, except saxagliptin, had a similar incidence of major cardiovascular adverse events (MACE) to placebos. Recently, several clinical trials have been published on the safety of cardiovascular disease regarding SGLT2 inhibitors and GLP-1 receptor agonists in patients with cardiovascular disease. They have shown benefits not only in the safety of cardiovascular events, but also in the secondary prevention of cardiovascular diseases. SGLT2 inhibitors and GLP-1 receptor agonists reduced MACE in diabetic patients at risk for cardiovascular disease. Specifically, empagliflozin and liraglutide reduced cardiovascular deaths by 38% and 22%, and reduced all-cause deaths by 32% and 15%, respectively. Evidence suggests that GLP-1 receptor agonists and SGLT2 inhibitors, when used in combination therapy for type 2 diabetes mellitus, may provide additional benefits in lowering blood sugar as well as in preventing cardiovascular and renal events. GLP-1 receptor agonists reduced atherosclerotic ischemic events, and SGLT2 inhibitors mainly reduced heart failure and renal events. Accumulation of clinical data for both drugs could reduce the outcome of cardiovascular events in patients with diabetes and create new treatment options.

Keyword

Type 2 Diabetes; Cardiovascular Disease; SGLT2 Inhibitor; GLP-1 Receptor Agonist
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