Pharmacologic strategies to reduce cardiovascular disease in type 2 diabetes mellitus: focus on SGLT‐2 inhibitors and GLP‐1 receptor agonists

Abstract

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‐1RAs) 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 (CVOTs) to determine their CV safety. These trials have largely demonstrated no major CV safety concerns. Most notably, the GLP‐1RAs 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‐1RAs seem to present more favourable effects on atherosclerotic events. In this review, we discuss the role of GLP‐1RAs 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.