Is One SGLT2 (Or GLP-1) Just Like Another for Cardiac Benefit?

Charles P. Vega, MD


December 31, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

The American College of Cardiology has issued an Expert Consensus Decision Pathway on the use of two major new classes of diabetes drugs: SGLT2 inhibitors and GLP-1 receptor agonists. While intended for cardiologists, who typically leave the glucose management to endocrinologists and primary care, the document provides good information for all of us, emphasizing that these two classes of drugs should be considered not just antidiabetic drugs but also cardiovascular (CV) agents.

The impetus for the consensus document was the growing body of research that documents the CV risk-reduction benefits of these two classes in patients with diabetes and atherosclerotic CV disease.

The key point is that the CV benefits of these drugs appear to be independent of their glucose-lowering effects.

The document includes summaries of the major CV outcome trials with two SGLT2 inhibitors (empagliflozin and canagliflozin) and four GLP-1RAs (liraglutide, semaglutide, exenatide, and lixisenatide). The consensus document notes that the SGLT2 inhibitors appear to reduce both major adverse cardiac events (MACE) and heart failure risk. Within this class, empagliflozin is currently the preferred agent, based on the available evidence and overall benefit-risk balance.

GLP-1s also offer reductions in MACE, and in this class, the most robust evidence is for liraglutide. Both classes of agents have benefits in reducing blood pressure and weight, and have a low risk for hypoglycemia.

The document notes that the evidence for specific agents in these classes is still emerging, with numerous trials ongoing. So we will all need to stay tuned.


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