ABSTRACT
Introduction
There are three major drug classes discussed in this review: dipeptidyl dipeptidase-4 (DPP4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAS), and sodium-glucose cotransporter-2 (SGLT2) inhibitors. A literature review of the landmark cardiovascular outcome trials from 2008 to 2021 was conducted.
Areas covered
The cumulative data shown in this review suggest that in patients with Type 2 Diabetes (T2D), SGLT2 inhibitors and GLP-1 RAS may reduce cardiovascular (CV) risk. Specifically, in the heart failure (HF) population, SGLT2 inhibitors have shown a reduction in hospitalizations in some randomized controlled trials (RCTs). DPP4 inhibitors have not shown a similar reduction in CV risk and even exhibited an increase in hospitalizations for HF in one RCT. It is important to note that the DPP4 inhibitors did not demonstrate an increase in major CV events, with the exception of the increase in HF hospitalizations in the SAVOR TIMI 53 trial.
Expert Opinion
Future avenues of research to explore include the use of novel antidiabetic agents to reduce post-myocardial infarction (MI) CV risk and arrhythmias independent of their use as diabetic agents.
Article highlights
DPP4 inhibitors did not demonstrate an increase or reduction in major CV events
DPP4 inhibitors have exhibited a slight increase in hospitalizations for HF in one RCT.
SGLT2 inhibitors and GLP-1 RAS may reduce cardiovascular (CV) risk
Specifically in the heart failure (HF) population, SGLT2 inhibitors have shown a reduction in hospitalizations in many randomized controlled trials (RCTs).
SGLT2 inhibitors reduce the progression of kidney disease in patients with Type 2 Diabetes
Expert opinion section highlighting future avenues of research over the next 5 years
Declaration of interests
The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contribution statement
L Michaud: contributed Abstract, Introduction, SGLT-2, GLP1, Conclusion, and Expert Opinion Sections. M Seplowe: contributed DPP4 – I and GLP1 sections. J Meir: contributed Future Directions Section. W Aronow: contributed editing and reference check as well as submitting author