Cardiovascular Impact of Newer Diabetes Medications

Cardiovascular disease (CVD) in the diabetic patient is both widespread and fatal in nature. In the United States, roughly two-thirds of deaths in diabetic patients are due to CVD. In addition to the increased morbidity and mortality of CVD in a patient with diabetes, the impact of this comorbidity on health care expenditure is staggering. Unfortunately, researches on the effects of strict glycemic control on cardiovascular (CV) events have been unable to demonstrate a conclusive benefit, despite improvement for microvascular complications. Newer glycemic agents, specifically the glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, have shown much more promising cardioprotective properties, and are valuable as an add-on therapy for patients who do not reach their hemoglobin A1c goal on metformin alone. Most of the drugs in GLP-1 RA and SGLT-2 inhibitor class have shown strong cardioprotective effects in well-designed cardiovascular outcome trials and all of them have demonstrated CV safety. Multiple SGLT-2 inhibitors have shown renal protective effects as well as prevent hospitalization for heart failure and hence, should be preferred over GLP-1 RAs in patients with concurrent T2DM and heart failure or CKD.