Antihyperglycemic drugs that improve cardiovascular outcomes and a model of diabetic cardiomyopathy

Abstract

Recent cardiovascular outcome trials (CVOTs) have transformed the landscape for the management of type 2 diabetes mellitus. In a remarkably short period of time, national and international guidelines have been overhauled to reflect the remarkable cardiovascular benefits of sodium/glucose linked transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor analogues (GLP-1RA) in mitigating cardiovascular risk. Both SGLT2is and GLP-1RAs remain second-line to metformin, reflecting the historical importance of this biguanide antihyperglycemic. In this review, these three very different antihyperglycemics are discussed in the light of CVOT data and of the preclinical data revealing remarkable pleiotropic signaling effects of these drugs. A model of diabetic cardiomyopathy is discussed, and the points of contact that these therapeutic interventions have upon this model may of help in understanding how each can be best targeted in this complex pathophysiological disease process.