Evidence continues to grow in support of the cardiovascular benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes and with or at high risk for atherosclerotic cardiovascular disease (CVD).

A panel of physician-scientists discussed how these two drug classes are changing the treatment of type 2 diabetes and reducing associated CVD risk in SGLT2i and GLP-1RA in Cardiovascular Disease—An Update for Clinical Practice in 2023. The session can be viewed on-demand by registered meeting participants at ADA2023.org. If you haven’t registered for the 83rd Scientific Sessions, register today to access the valuable meeting content through August 28.

“These drugs have directly impacted contemporary guidelines and society recommendations for the mitigation of cardiovascular risk, independent of glucose control. Not to suggest that glucose control is not important, but let’s not let it get in the way of actually applying these medications, as they’ve been proven in trials,” said Darren K. McGuire, MD, MHSc. “We should prioritize them as a group in cardiology, in endocrinology, and in primary care.”

Dr. McGuire, Distinguished Teaching Professor and the Jere H. Mitchell, M.D. Distinguished Chair in Cardiovascular Science, University of Texas Southwestern Medical Center, provided an overview of how SGLT2 inhibitors and GLP-1 receptor agonists have impacted clinical practice for cardiologists.

“All of our worlds changed in 2015 when the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) results were presented and we, for the first time in the history of diabetes management and research, had a positive clinical outcomes trial that could inform our decision-making for patients with, or at high risk for, cardiovascular disease,” Dr. McGuire said.

The beneficial effects on cardiovascular outcomes were also being demonstrated in GLP-1 receptor agonist clinical trials, he added.

Pam R. Taub, MD, FACC, FASPC, Director of the Step Family Foundation Cardiovascular Rehabilitation and Wellness Center and Professor of Medicine, University of California San Diego Health System, further discussed the clinical impact of SGLT2 inhibitors and GLP-1 receptor agonists in CVD and diabetes, emphasizing the growing overlap in cardiovascular and diabetes care.

“One thing that I think has become very clear is that type 2 diabetes is a CVD,” Dr. Taub said. “As cardiologists, we know how to manage coronary disease, we know how to manage heart failure, and we know how to manage arrhythmias, but we need to know how to manage type 2 diabetes. Because when you look at the mechanisms that underlie type 2 diabetes, they are the same mechanisms that underlie atherosclerotic CVD: dyslipidemia, inflammation, hypercoagulability, endothelial dysfunction.”

Studies are also looking at GLP-1 receptor agonists for new indications, such as non-alcoholic fatty liver disease (NAFLD), Alzheimer’s disease, stroke, sleep apnea, and atrial fibrillation.

“We’re really in a new era of cardiometabolic disease that’s been ushered in by both the SGLT2 inhibitors and the GLP-1 receptor agonists and we, as clinicians, really need to harness the pleiotropic effect of these medications to really treat the wide spectrum of cardiometabolic disease,” Dr. Taub said.

Carlos Santos-Gallego, MD, Instructor of Cardiology, Icahn School of Medicine at Mount Sinai, concluded the presentations with a discussion of ongoing studies exploring the potential mechanisms of action of SGLT2 inhibitors in heart failure and the recent approval of a novel new agent.

“SGLT inhibition has been demonstrated to improve outcomes both in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF),” Dr. Santos-Gallego said. “A new addition to this drug family, sotagliflozin, provides dual SGLT1/2 inhibition, not only SGLT2 blockade, and was approved by the U.S. Food and Drug Administration (FDA) in May for treatment of heart failure independently of ejection fraction. The mechanisms of benefit of SGLT2 inhibition on heart failure are not clear and are still under investigation, but SGLT2 inhibitors are a very promising drug for diabetes and heart failure.”