Impact of Glucose-Lowering Medications on Cardiovascular and Metabolic Risk in Type 2 Diabetes

• Authors: Angelo Maria Patti, University of Palermo; Ali A. Rizvi, Emory University; Rosaria Vincenza Giglio, University of Palermo; Anca Pantea Stoian, Carol Davila University; Daniela Ligi, University Carlo Bo of Urbino; Ferdinando Mannello, University Carlo Bo of Urbino
• Journal Title: Journal of Clinical Medicine
• Volume: Volume 9, Number 4
• Publisher: MDPI | 2020-04-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/jcm9040912
• Subjects: Health Sciences, Health Care Management; Health Sciences, Nutrition; Health Sciences, Public Health; Chemistry, Biochemistry
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; cardiovascular risk; dipeptidyl peptidase-4 inhibitors; glucagon like peptide-1 receptor agonists; sodium glucose cotransporter-2 inhibitors; type 2 diabetes mellitus; Peptide-1 receptor agonist; Base line characteristics; Heart failure; Glycemic control; Itca 650; Outcomes; Pioglitazone; Exenatide; Safety; trial

Abstract

Type 2 Diabetes Mellitus (T2DM) is associated with a high risk of atherosclerotic cardiovascular (CV) disease. Among the well-known pathophysiologic factors, crucial roles are played by endothelial dysfunction (caused by oxidative stress and inflammation hyperglycemia-linked), increased activity of nuclear factor kB, altered macrophage polarization, and reduced synthesis of resident endothelial progenitor cells. As consequence, a potentially rapid progression of the atherosclerotic disease with a higher propensity to unstable plaque is arguable, finally leading to significantly increased cardiovascular mortality. Main managements are focused on both prevention and early diagnosis, by targeted treatment of hyperglycemia and vascular complications. Innovative therapeutic approaches for T2DM seek to customize the antidiabetic treatment to each patient in order to optimize glucose-lowering effects, minimize hypoglycemia and adverse effects, and prevent cardiovascular events. The newer drugs (e.g., Glucagon Like Peptide-1 Receptor Agonists, GLP-1 RAs; Sodium GLucose coTransporter-2 inhibitors, SGLT2is; DiPeptidyl Peptidase-4 inhibitors, and DPP4is) impact body weight, lipid parameters, and blood pressure, as well as endothelial (dys)functions, inflammatory markers, biomarkers of both oxidative stress, and subclinical atherosclerosis. The present review summarizes the results of the main trials focused on the cardiovascular safety of these drugs from the CV standpoint.