Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
IRCCS Neuromed-Pozzilli (IS), Pozzilli, Italy.
Adv Exp Med Biol. 2021;1307:193-212. doi: 10.1007/5584_2020_494.
The risk of cardiovascular disease (CVD) (myocardial infarction, stroke, peripheral vascular disease) is twice in type 2 diabetes (T2D) patients compared to non-diabetic subjects. Furthermore, cardiovascular disease (CV) is the leading cause of death in patients with T2D.In the last years several clinical intervention studies with new anti-hyperglycaemic drugs have been published, and they have shown a positive effect on the reduction of mortality and cardiovascular risk in T2D patients. In particular, these studies evaluated sodium/glucose-2 cotransporter inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP-1RA).In secondary prevention, it was clearly demonstrated that SGLT2i and GLP-1RA drugs reduce CV events and mortality, and new guidelines consider now these drugs as first choice (after metformin) in the treatment of T2D; there are also some signs that they may be effective also in primary prevention of CVD. However, the mechanisms involved in cardiovascular protection are not yet fully understood, but they appear to be both "glycaemic" and "extra-glycaemic".In this review, we will examine the fundamental results of the clinical trials on SGLT2i and GLP-1RA, their clinical relevance in term of treatment of T2D, and we will discuss the mechanisms that may explain how these drugs exert their cardiovascular protective effects.
心血管疾病（CVD）（心肌梗死、中风、外周血管疾病）的风险在 2 型糖尿病（T2D）患者中是无糖尿病患者的两倍。此外，心血管疾病（CV）是 T2D 患者死亡的主要原因。近年来，已经发表了几项关于新型抗高血糖药物的临床干预研究，这些研究表明它们对降低 T2D 患者的死亡率和心血管风险具有积极作用。特别是，这些研究评估了钠/葡萄糖-2 共转运蛋白抑制剂（SGLT2i）和胰高血糖素样肽-1 受体激动剂（GLP-1RA）。在二级预防中，已经清楚地表明 SGLT2i 和 GLP-1RA 药物可减少 CV 事件和死亡率，新指南现在将这些药物视为 T2D 治疗的首选药物（继二甲双胍之后）；也有一些迹象表明它们在 CVD 的一级预防中可能也有效。然而，心血管保护的机制尚未完全了解，但它们似乎既有“血糖依赖性”，也有“血糖非依赖性”。在这篇综述中，我们将检查 SGLT2i 和 GLP-1RA 的临床试验的基本结果，以及它们在 T2D 治疗方面的临床相关性，并讨论可能解释这些药物如何发挥其心血管保护作用的机制。
