Impact of glucagon-like peptide 1 receptor agonists and sodium-glucose transport protein 2 inhibitors on blood pressure and lipid profile

ABSTRACT

Introduction

Type 2 diabetes mellitus (T2DM) is associated with increased prevalence of cardiovascular (CV) disease (CVD). Optimal anti-hyperglycemic agents should include control of multiple CV risk factors (RF) to improve macrovascular and microvascular complications, as well as glycemia.

Areas covered

In this narrative review, the authors focus on the effects of glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose transport protein 2 inhibitors (SGLT2i) on blood pressure (BP) and the lipid profile, two well-established CV RF.

Expert opinion

Results from recent CV outcome trials (CVOTs), showed the impact of GLP-1 RA and SGLT2i on BP and lipid levels. These classes of medication can alter cardiac function by affecting the process of atherosclerosis and/or hemodynamic status. The results of published GLP1-RA and SGLT2i CVOTs have shown multifactorial benefits; in addition to the main effects on glycemia and body weight (BW), there are also positive but moderate effects on BP and lipid levels. Full advantage of the pleiotropic benefit of these agents should be taken to prevent CV events.

KEYWORDS:

• Atherosclerosis
• blood pressure
• glucagon-like peptide 1 receptor agonists
• lipid profile
• sodium-glucose transport protein 2 inhibitors

Article highlights

• The pathophysiology of type 2 diabetes mellitus (T2DM) is complex, with multiple underlying defects.

• Hyperglycaemia alone only has a mild contribution to decreasing the risk of cardiovascular (CV) events, which indicates the importance of reducing other risk factors (RF) such as hypertension, dyslipidemia and obesity.

• The main drivers of CV disease (CVD) are the process of atherosclerosis and haemodynamic status, which mostly affect coronary blood vessels and lead to left ventricular (LV) hypertrophy.

• Glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose transport protein 2 inhibitors (SGLT2i) can alter cardiac function by affecting these processes the process of atherosclerosis and haemodynamic status, respectively.

• Determining the isolated effect of GLP-1 RA and SGLT2i on lipid levels and blood pressure requires well-designed studies, with the aim of assessing their real lipid lowering and antihypertensive potential, and any consequent translation into clearly defined CV outcomes.

This box summarizes key points contained in the article.

Declaration of interest

E Muzurovic is a speaker for Novo Nordisk, Sanofi, AstraZeneca, Servier and Merck & Co. while DP Mikhailidis has given talks, acted as a consultant for, or attended conferences sponsored by Amgen Inc, Novo Nordisk and Libytec. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One referee declares over the past two years, research grants, fees for lectures or has participated on advisory boards for Merck Sharp & Dohme, AstraZeneca, Novartis, Boehringer Ingelheim, Sanofi, Neopharmed Gentili, MundiPharma, Janssen Pharmaceuticals, Novo Nordisk, Eli Lilly and Company, Servier, Daiichi Sankyo, Bayer, and Takeda. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript has not been funded.