Department of Clinical and Experimental Medicine, University of Pisa, Italy; Section of Diabetes and Metabolic Diseases, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Section of Diabetes and Metabolic Diseases, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Atherosclerosis. 2024 Jul;394:117560. doi: 10.1016/j.atherosclerosis.2024.117560. Epub 2024 Apr 23.
Despite the risk of atherosclerosis has progressively declined over the past few decades, subjects with type 2 diabetes mellitus (T2DM) continue to experience substantial excess of atherosclerotic cardiovascular disease (ASCVD)-related events. Therefore, there is urgent need to treat ASCVD disease in T2DM earlier, more intensively, and with greater precision. Many factors concur to increase the risk of atherosclerosis, and multifactorial intervention remains the basis for effective prevention or reduction of atherosclerotic events. The role of anti-hyperglycemic medications in reducing the risk of ASCVD in subjects with T2DM has evolved over the past few years. Multiple cardiovascular outcome trials (CVOTs) with new and emerging glucose-lowering agents, namely SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1-RA), have demonstrated significant reductions of major cardiovascular events and additional benefits. This robust evidence has changed the landscape for managing people with T2DM. In addition to glycemic and ancillary extra-glycemic properties, SGLT2i and GLP1-RA might exert favorable effects on subclinical and clinical atherosclerosis. Therefore, the objective of this review is to discuss the available evidence supporting anti-atherosclerotic properties of SGLT2i and GLP1-RA, with a quick nod to sotagliflozin and tirzepatide.
尽管在过去几十年中，动脉粥样硬化的风险逐渐降低，但 2 型糖尿病（T2DM）患者仍然经历大量的动脉粥样硬化性心血管疾病（ASCVD）相关事件。因此，迫切需要更早、更强化、更精准地治疗 T2DM 的 ASCVD 疾病。许多因素共同增加了动脉粥样硬化的风险，多因素干预仍然是有效预防或减少动脉粥样硬化事件的基础。抗高血糖药物在降低 T2DM 患者 ASCVD 风险方面的作用在过去几年中发生了变化。多项新型和新兴的降糖药物，即 SGLT2 抑制剂（SGLT2i）和 GLP-1 受体激动剂（GLP1-RA）的心血管结局试验（CVOT）表明，主要心血管事件显著减少，并带来额外获益。这一有力证据改变了 T2DM 患者的管理格局。除了血糖和辅助性的血糖外作用外，SGLT2i 和 GLP1-RA 可能对亚临床和临床动脉粥样硬化产生有利影响。因此，本综述的目的是讨论支持 SGLT2i 和 GLP1-RA 的抗动脉粥样硬化特性的现有证据，并简要介绍 sotagliflozin 和 tirzepatide。
