posted on 2019-09-02, 16:31authored byGaurav S. Gulsin, Matthew P. M. Graham-Brown, Melanie J. Davies, Gerry P. McCann
In recent large-scale cardiovascular outcomes trials, two new classes of glucose-lowering medications – sodium
glucose co-transporter 2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1RAs) –
demonstrated cardiovascular benefits in adults with type 2 diabetes mellitus (T2DM). These findings have
prompted growing optimism amongst clinicians regarding the potential for these agents to reduce the burden
of cardiovascular disease in people with T2DM. GLP-1RAs and SGLT2i are now advocated as second-line agents
in European and U.S. guidelines for management of both hyperglycaemia and for primary prevention of
cardiovascular disease in people with T2DM. Given the high prevalence of T2DM in patients with
cardiovascular disease, cardiologists will increasingly encounter these agents in routine clinical practice. In this
review, we summarise evidence from cardiovascular outcomes trials of GLP-1RAs and SGLT2i, give practical
advice on prescribing, and detail safety considerations associated with their use. We also highlight areas where
further work is needed, giving details on active clinical trials. The review aims to familiarise cardiologists with
these emerging treatments, which will be increasingly encountered in clinical practice, given the expanding
representation of T2DM in patients with cardiovascular disease. Whether these drugs will be initiated by
cardiologists remains to be determined.
GSG is funded through a British Heart Foundation Clinical Research Training Fellowship (CRTF 32190, GS
Gulsin). GPM is funded through a National Institute for Health Research (NIHR) Research Professorship (RP2017-08-ST2-007, GP McCann). All authors receive support from the NIHR Leicester Biomedical Research
Centre and the NIHR Leicester Clinical Research Facility.
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