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Review
. 2020 Mar 26;9(4):912.
doi: 10.3390/jcm9040912.

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

Angelo Maria Patti  1 , Ali A Rizvi  2 , Rosaria Vincenza Giglio  1 , Anca Pantea Stoian  3 , Daniela Ligi  4 , Ferdinando Mannello  4
Affiliations
Review

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

Angelo Maria Patti et al. J Clin Med. .

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.

Keywords: cardiovascular risk; dipeptidyl peptidase-4 inhibitors; glucagon like peptide-1 receptor agonists; sodium glucose cotransporter-2 inhibitors; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the main routes, tissue biotargets, mode of actions, and effects of glucose-lowering medications, and their impact on cardiovascular risk in patients with Type 2 Diabetes. The data are obtained from both scientific literature and CardioVascular Outcome Trials, carefully assessing the cardiovascular safety of the main newest glucose-lowering medications.
See this image and copyright information in PMC

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