Repurposing Antidiabetic Drugs for Cardiovascular Disease

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Metabolic diseases and type 2 diabetes pose global health challenges, increasing cardiovascular risk.
• Current diabetes treatment primarily focuses on glucose lowering, often insufficient for managing associated cardiovascular complications like atherosclerosis and myocardial infarction.

Purpose of the Study:

• To review the cardioprotective effects of antidiabetic agents, focusing on SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1-RA).
• To explore the proposed mechanisms underlying these cardiovascular benefits, including insights from preclinical studies.
• To discuss the potential repurposing of these antidiabetic drugs for cardiovascular disease management.

Main Methods:

• Systematic review of evidence from preclinical studies and recent cardiovascular outcome trials.
• Analysis of data concerning SGLT2i, GLP1-RA, DPP4 inhibitors (DPP4i), and metformin in patients with high cardiovascular risk.
• Examination of drug effects independent of glycemic control.

Main Results:

• Cardiovascular outcome trials demonstrated significant cardioprotective benefits of GLP1-RA and SGLT2i in type 2 diabetes patients with high cardiovascular risk.
• These benefits were observed independently of glycemic control, suggesting mechanisms beyond glucose lowering.
• The effects of DPP4i and metformin were also considered, with some contrasting findings.

Conclusions:

• GLP-1 receptor agonists and SGLT2 inhibitors provide substantial cardiovascular protection in patients with type 2 diabetes and high cardiovascular risk.
• The cardioprotective effects are independent of glycemic control, highlighting novel therapeutic mechanisms.
• These antidiabetic agents show promise for repurposing to improve cardiovascular outcomes in non-diabetic individuals with cardiovascular diseases.