Diabetes and cardiovascular disease: from new mechanisms to new therapies

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Diabetes mellitus, particularly type 2, is a primary risk factor for cardiovascular diseases (CVDs), the leading cause of mortality in affected individuals.
• Hyperglycemia, hypoglycemia, and glycemic variability critically influence both macrovascular and microvascular complications in diabetic patients.
• Understanding the intricate relationship between diabetes and the cardiovascular system is crucial for effective patient management.

Purpose of the Study:

• To provide an overview of the impact of type 2 diabetes on the cardiovascular system.
• To review novel therapeutic strategies for managing gluco-metabolic disturbances in high-cardiovascular-risk diabetic patients.
• To evaluate the cardiovascular benefits and underlying mechanisms of new antidiabetic drug classes.

Main Methods:

• Literature review of current knowledge on diabetes and cardiovascular impact.
• Analysis of data from large randomized clinical trials (e.g., EMPA-REG, LEADER, SUSTAIN-6, CANVAS).
• Examination of recent studies and meta-analyses on new drug classes: glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Main Results:

• New therapeutic agents, including GLP-1 receptor agonists and SGLT2 inhibitors, demonstrate significant benefits in reducing major adverse cardiovascular events (MACE).
• Clinical trials show these drugs decrease risks of cardiovascular death, myocardial infarction, and stroke in high-risk diabetic populations.
• Evidence suggests that the cardiovascular benefits may extend beyond glucose-lowering effects, warranting further investigation.

Conclusions:

• Novel drug classes offer significant cardiovascular protection in type 2 diabetes patients at high cardiovascular risk.
• The mechanisms underlying these cardioprotective effects are multifaceted and not solely attributed to glycemic control.
• Glycemic control and the specific actions of new antidiabetic medications are critical factors influencing survival in diabetic patients with cardiovascular risk.