[Incretin therapies and multifactorial clinical approach to cardiometabolic patients]

Atherogenic dyslipidemia, hypertension and obesity are frequently present in type 2 diabetes mellitus (T2DM) and contribute to the overall increase in cardiovascular (CV) morbidity and mortality associated with this disease. It is therefore highly desirable that treatments aimed to improving glucose control in T2DM do not negatively impact such risk factors. It would be very helpful, instead, if treatments implemented to lower blood glucose could also be efficacious in mitigating hypertension, obesity and dyslipidemia, so to improve global CV risk profile in these patients. Glucagon-like peptide 1 receptor agonists (GLP-1RA) can efficiently ameliorate blood glucose profile in diabetic subjects with no or minimal risk of hypoglycemia: besides, the use of these agents is associated with weight loss, decreased blood pressure and a modestly but significantly improved lipid profile. Clinical trials and meta-analyses have also demonstrated that patients treated with exenatide and, to a larger extent, with liraglutide are significantly more likely to achieve the composite endpoint of glycated hemoglobin <7%, no hypoglycemia and no weight gain as compared to patients exposed to other diabetes treatment, including dipeptidyl peptidase-4 inhibitors and insulin glargine. Thus, even if randomized controlled outcome trials definitely demonstrating a reduction in CV events in GLP-1RA treated subjects are still lacking, it is nevertheless evident that treatment with GLP-1RA, by its action on CV risk factors, could contribute to mitigate the risk profile in T2DM.