Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors for Cardiovascular Disease Prevention
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REVIEW ARTICLE
Sodium‑Glucose Cotransporter‑2 (SGLT‑2) Inhibitors for Cardiovascular Disease Prevention Jessica Reid1,2 · Khyatiben Rana1 · Stephanie Niman1 · Mae Sheikh‑Ali3 · Todd Lewis4 · Rushab R. Choksi1 · Rebecca F. Goldfaden1
© Springer Nature Switzerland AG 2020
Abstract Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Because of these associated risks, managing diabetes and CVD, including heart failure (HF), has become a joint effort to reduce the risk of adverse outcomes. Although many patients with T2DM are receiving preventive therapies for CVD, their residual risk remains high for atherosclerotic CVD (ASCVD). Recent data regarding the use of antidiabetic medications to prevent negative cardiovascular outcomes has revealed a positive association with reduced major adverse cardiovascular events (MACE). One class of medications, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, are at the forefront of the cardiovascular outcomes prevention discussion. The clinical data presented in this review indicate the potential cardiovascular benefits of SGLT-2 inhibitors in patients with CVD and its potential value as a treatment option in preventing CVD in various patient populations.
Key Points
1 Introduction
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus.
Countless patients with type 2 diabetes mellitus (T2DM) are at increased risk of major adverse cardiovascular events (MACE) from coexistent atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and/or renal disease [1]. Managing T2DM often requires the use of multiple antidiabetic agents, which can introduce challenges such as pill burden and an increased incidence of adverse events [2]. To maintain glycemic control in patients with T2DM, treatment intensification may be necessary, and practitioners must consider therapy options that simultaneously have clinical benefits on comorbid cardiovascular conditions [2]. This is important since data from numerous pathological and epidemiological studies have indicated that diabetes is an independent risk factor and precursor for cardiovascular disease (CVD), with approximately 65% of deaths in patients with diabetes attributed to CVD [3]. Furthermore, patients with diabetes who develop CVD often have a worse morbidity and mortality prognosis than patients who have CVD without diabetes [3]. Such considerations have strongly encouraged the American Diabetes Association (ADA) to highlight antidiabetic therapy that not only targets glycated hemoglobin (HbA1c) lowering but also aids in the reduction of blood pressure (BP) and weight, with added benefits for HF and renal disease protection to reduce the risk of
The clinical data presented in this review indicate the potential cardiovascular benefits of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with CVD and its potential value as a treatment option in preventing CVD in various patient
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