Journal
MED
Volume 2, Issue 11, Pages 1203-1230Publisher
CELL PRESS
DOI: 10.1016/j.medj.2021.10.004
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Funding
- CIHR [154321]
- Banting and Best Diabetes Centre-Novo Nordisk Chair in Incretin Biology
- Sinai Health Novo Nordisk Fund in regulatory peptides
- Department of Medicine, University of Toronto Merit Award
- CIHR, Diabetes Canada
- Heart and Stroke Richard Lewar Centre of Excellence
- Ontario Ministry of Colleges and Universities Early Researcher Award [ER15-11-037]
- Heart and Stroke Foundation of Canada
- Women's College Research Institute
- Department of Medicine, Women's College Hospital
- Peter Munk Cardiac Centre, Toronto General Hospital
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CVOTs for GLP1RA and SGLT2i show that these drugs reduce rates of major adverse cardiovascular events and have protective effects on kidney and heart function, making them promising therapies for both people with and without type 2 diabetes.
Cardiovascular and renal outcome trials (CVOTs) for glucagon-likepeptide-1 receptor agonists (GLP1RA) and sodium-glucose co transporter 2 inhibitors (SGLT2i) highlight new options for people with and without type 2 diabetes (T2D). Drugs within these classes reduce rates of major adverse cardiovascular events (MACE), with SGLT2i simultaneously attenuating decline in kidney function. SGLT2i reduce rates of heart failure in people with and without T2D, whereas GLP1RA lower rates of myocardial infarction and stroke in people with T2D with or without preexisting cardiovascular disease. Mechanistically, SGLT2 and the GLP-1 receptor are expressed at low levels in the heart, and within some blood vessels and immune cells, implying indirect mechanisms of action for the preservation of ventricular function, and reduction of atherosclerosis. SGLT2i likely preserve renal function through the alteration of glomerular hemodynamics. These two drug classes enable organ protection and reduced mortality in people with T2D and represent promising therapies for some people without T2D.
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