Cardioprotective and nephroprotective potential of sodium-glucose cotransporter type 2 inhibitors in patients with type 2 diabetes mellitus

Diabetes mellitus (DM) increases the risk of developing cardiovascular diseases (CVD): coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), acute cerebrovascular accidents (CVA), as well aorta and peripheral arteries diseases. In addition, type 2 diabetes mellitus (T2DM) is the leading cause of chronic kidney disease (CKD). The combination of T2DM with these cardiorenal comorbidities increases the risk of major adverse cardiovascular events (MACE) as well as mortality from CVD and allcause mortality. Cardiorenal damage in type 2 DM is based on insulin resistance, development of inflammation and oxidative stress, which leads to the formation of interstitial fibrosis in myocardium (diabetic cardiomyopathy), large vessels and kidneys (diabetic nephropathy). Advanced glycosylation end-products deposition, lipotoxicity, along with microcirculatory dysfunction associated with type 2 diabetes, as well as dyslipidemia and hypertension, further contribute to cardiorenal injury. The presence of CVD and CKD in T2DM and the commonality of pathophysiological changes in these conditions dictate the need to prescribe hypoglycemic drugs with cardioprotective and nephroprotective properties that reduce the risk of adverse cardiovascular events and renal risks. This article systematizes and analyzes the latest studies on the effect of sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors), in particular dapagliflozin, on the course of various CVD and CKD in combination with T2DM. The cardio-nephroprotective potential of SGLT-2 inhibitors, cardiovascular and renal benefits when this group of hypoglycemic drugs is prescribed to patients with type 2 diabetes are described. The article provides an analysis of studies confirming the safety and effectiveness of SGLT-2 inhibitors, in particular dapagliflozin, in terms of cardio- and nephroprotection.