GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data
Abstract Patients with type 2 diabetes (T2DM) have a substantial risk of developing cardiovascular disease. The strong connection between the severity of hyperglycaemia, metabolic changes secondary to T2DM and vascular damage increases the risk of macrovascular complications. There is a challenging...
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doaj-a4f19608359d4aa9af44e27573ba74d92020-11-25T02:14:53ZengBMCCardiovascular Diabetology1475-28402018-12-0117111910.1186/s12933-018-0800-2GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome dataAndrei C. Sposito0Otávio Berwanger1Luiz Sérgio F. de Carvalho2José Francisco Kerr Saraiva3Atherosclerosis and Vascular Biology Laboratory (AtheroLab), Cardiology Division, Faculty of Medical Sciences, State University of Campinas (Unicamp)Academic Research Organization (ARO), Albert Einstein HospitalAtherosclerosis and Vascular Biology Laboratory (AtheroLab), Cardiology Division, Faculty of Medical Sciences, State University of Campinas (Unicamp)Cardiology Division, Pontifical Catholic University of Campinas Medicine SchoolAbstract Patients with type 2 diabetes (T2DM) have a substantial risk of developing cardiovascular disease. The strong connection between the severity of hyperglycaemia, metabolic changes secondary to T2DM and vascular damage increases the risk of macrovascular complications. There is a challenging demand for the development of drugs that control hyperglycaemia and influence other metabolic risk factors to improve cardiovascular outcomes such as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina and heart failure (major adverse cardiovascular events). In recent years, introduction of the new drug class of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has changed the treatment landscape as GLP-1RAs have become well-established therapies in T2DM. The benefits of GLP-1RAs are derived from their pleiotropic effects, which include appetite control, glucose-dependent secretion of insulin and inhibition of glucagon secretion. Importantly, their beneficial effects extend to the cardiovascular system. Large clinical trials have evaluated the cardiovascular effects of GLP-1RAs in patients with T2DM and elevated risk of cardiovascular disease and the results are very promising. However, important aspects still require elucidation, such as the specific mechanisms involved in the cardioprotective effects of these drugs. Careful interpretation is necessary because of the heterogeneity across the trials concerning the definition of cardiovascular risk or cardiovascular disease, baseline characteristics, routine care and event rates. The aim of this review is to describe the main clinical aspects of the GLP-1RAs, compare them using data from both the mechanistic and randomized controlled trials and discuss potential reasons for improved cardiovascular outcomes observed in these trials. This review may help clinicians to decide which treatment is most appropriate in reducing cardiovascular risk in patients with T2DM.http://link.springer.com/article/10.1186/s12933-018-0800-2Cardiovascular outcomesDiabetesGLP-1 receptor agonistObesity |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Andrei C. Sposito Otávio Berwanger Luiz Sérgio F. de Carvalho José Francisco Kerr Saraiva |
spellingShingle |
Andrei C. Sposito Otávio Berwanger Luiz Sérgio F. de Carvalho José Francisco Kerr Saraiva GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data Cardiovascular Diabetology Cardiovascular outcomes Diabetes GLP-1 receptor agonist Obesity |
author_facet |
Andrei C. Sposito Otávio Berwanger Luiz Sérgio F. de Carvalho José Francisco Kerr Saraiva |
author_sort |
Andrei C. Sposito |
title |
GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data |
title_short |
GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data |
title_full |
GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data |
title_fullStr |
GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data |
title_full_unstemmed |
GLP-1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data |
title_sort |
glp-1ras in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data |
publisher |
BMC |
series |
Cardiovascular Diabetology |
issn |
1475-2840 |
publishDate |
2018-12-01 |
description |
Abstract Patients with type 2 diabetes (T2DM) have a substantial risk of developing cardiovascular disease. The strong connection between the severity of hyperglycaemia, metabolic changes secondary to T2DM and vascular damage increases the risk of macrovascular complications. There is a challenging demand for the development of drugs that control hyperglycaemia and influence other metabolic risk factors to improve cardiovascular outcomes such as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina and heart failure (major adverse cardiovascular events). In recent years, introduction of the new drug class of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has changed the treatment landscape as GLP-1RAs have become well-established therapies in T2DM. The benefits of GLP-1RAs are derived from their pleiotropic effects, which include appetite control, glucose-dependent secretion of insulin and inhibition of glucagon secretion. Importantly, their beneficial effects extend to the cardiovascular system. Large clinical trials have evaluated the cardiovascular effects of GLP-1RAs in patients with T2DM and elevated risk of cardiovascular disease and the results are very promising. However, important aspects still require elucidation, such as the specific mechanisms involved in the cardioprotective effects of these drugs. Careful interpretation is necessary because of the heterogeneity across the trials concerning the definition of cardiovascular risk or cardiovascular disease, baseline characteristics, routine care and event rates. The aim of this review is to describe the main clinical aspects of the GLP-1RAs, compare them using data from both the mechanistic and randomized controlled trials and discuss potential reasons for improved cardiovascular outcomes observed in these trials. This review may help clinicians to decide which treatment is most appropriate in reducing cardiovascular risk in patients with T2DM. |
topic |
Cardiovascular outcomes Diabetes GLP-1 receptor agonist Obesity |
url |
http://link.springer.com/article/10.1186/s12933-018-0800-2 |
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