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World J Diabetes. May 15, 2019; 10(5): 291-303
Published online May 15, 2019. doi: 10.4239/wjd.v10.i5.291
Novel pharmacological therapy in type 2 diabetes mellitus with established cardiovascular disease: Current evidence
Leonardo Pozo, Fatimah Bello, Andres Suarez, Francisco E Ochoa-Martinez, Yamely Mendez, Chelsea H Chang, Salim Surani
Leonardo Pozo, Fatimah Bello, Andres Suarez, Chelsea H Chang, University of Texas Rio Grande Valley - Doctors Hospital at Renaissance Internal Medicine Residency Program, Edinburg, TX 78539, United States
Francisco E Ochoa-Martinez, Faculty of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital “Dr. José Eleuterio González”, Monterrey, NL 66455, Mexico
Yamely Mendez, Faculty of Medicine “Dr. Alberto Romo Caballero”, Universidad Autonoma de Tamaulipas, Houston, TX 77058, United States
Salim Surani, Medical Critical Care Services, Christus Spohn Hospitals-Corpus Christi, Corpus Christi, TX 78404, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Salim Surani, BSc, FACC, FACP, FCCP, MD, Professor, Medical Critical Care Services, Christus Spohn Hospitals-Corpus Christi, 701 Ayers street, Corpus Christi, TX 78404, United States. srsurani@hotmail.com
Telephone: +1-361-8857722 Fax: +1-361-8507563
Received: April 1, 2019
Peer-review started: April 4 2019
First decision: May 8, 2019
Revised: May 13, 2019
Accepted: May 13, 2019
Article in press: May 14, 2019
Published online: May 15, 2019
Abstract

Cardiovascular diseases (CVDs) remain the leading cause of death in the world and in most developed countries. Patients with type 2 diabetes mellitus (T2DM) suffer from both microvascular and macrovascular diseases and therefore have higher rates of morbidity and mortality compared to those without T2DM. If current trends continue, the Center for Disease Control and Prevention estimates that 1 in 3 Americans will have T2DM by year 2050. As a consequence of the controversy surrounding rosiglitazone and the increasing prevalence of diabetes and CVDs, in 2008 the Food and Drug Administration (FDA) established new expectations for the evaluation of new antidiabetic agents, advising for pre and, in some cases, post-marketing data on major cardiovascular events. As a direct consequence, there has been a paradigm shift in new antidiabetic agents that has given birth to the recently published American Diabetes Association/European Association for the Study of Diabetes consensus statement recommending sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1RA) in patients with T2DM and established CVD. As a result of over a decade of randomized placebo controlled cardiovascular outcome trials, the aforementioned drugs have received FDA approval for risk reduction of cardiovascular (CV) events in patients with T2DM and established CV disease. SGLT2i have been shown to have a stronger benefit in patients with congestive heart failure and diabetic kidney disease when compared to their GLP-1RA counterparts. These benefits are not withstanding additional considerations such as cost and the multiple FDA Black Box warnings. This topic is currently an emerging research area and this mini-review paper examines the role of these two novel classes of drugs in patients with T2DM with both confirmed, and at risk for, CVD.

Keywords: Type 2 diabetes mellitus, Glucagon-like-peptide 1 agonists, Sodium-glucose cotransporter-2 inhibitor, Cardiovascular disease, Major adverse cardiovascular event

Core tip: Cardiovascular diseases are of significant concern in patients with type 2 diabetes mellitus. Novel therapies offer a new opportunity for cardiovascular risk reduction and add complexity in terms of selecting antihyperglycemic treatment. These pharmacological therapies, however, also have additional considerations.