Cardiovascular Risk Reduction in Type 2 Diabetes: Therapeutic Potential of Dapagliflozin

Ioannis Avgerinos,1 Aris Liakos,1,2 Apostolos Tsapas,1–3 Eleni Bekiari1,2 1Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3Harris Manchester College, University of Oxford, Oxford, UKCorrespondence: Ioannis AvgerinosClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, GreeceEmail iavgerik@auth.grAbstract: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are currently used as second-line therapy for treatment of patients with type 2 diabetes mellitus (T2DM). Based on the results from dedicated cardiovascular outcome trials (CVOTs), current guidelines suggest the use of SGLT-2 inhibitors for patients with T2DM and established atherosclerotic cardiovascular disease (ASCVD) or heart failure. The cardiovascular safety profile of dapagliflozin, a novel SGLT-2 inhibitor, has been recently explored in large CVOTs. Treatment with dapagliflozin reduced the risk of the composite outcome of cardiovascular mortality or hospitalization for heart failure compared with placebo, both among patients with T2DM who had or were at risk of ASCVD, as well as among patients with heart failure and a reduced ejection fraction. The observed cardiovascular benefit was mainly attributed to the lower rate of hospitalization for heart failure. Additionally, treatment with dapagliflozin was associated with a lower rate of renal adverse events. The safety and efficacy of dapagliflozin on glycemic and non-glycemic endpoints has been also well established in a series of other clinical trials and real-word studies. The aim of the present review is to summarize the available evidence regarding the cardiovascular profile of dapagliflozin in patients with T2DM. Overall, by reducing the rate of hospitalization for heart failure and ameliorating renal adverse events, dapagliflozin is a valuable option for the management of patients with T2DM and multiple cardiovascular risk factors.Keywords: dapagliflozin, sodium-glucose co-transporter 2 inhibitors, SGLT-2 inhibitors, type 2 diabetes, cardiovascular risk