Combined use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors for cardiovascular protection

Abstract: Among the various treatments for type 2 diabetes during the initial period, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors have been considered together as agents with separate cardiometabolic benefits, given their limited glucose-lowering effects. GLP-1 RAs are reported to inhibit atherosclerosis through several physiological processes, including increased blood flow in endothelial tissues, decreased inflammation, increased antioxidant levels, and improved lipid profile. There is a similar situation with SGLT2 inhibitors, and the explanation for this is different yet complementary, as these drugs cause a decrease in both cardiac preload and afterload and, at the same time, increase vascular permeability, diuresis, and more efficient energy usage by the heart. Thus, they have been affirmed by extensive clinical trials, which show that, although these drugs may harm patients, they do not result in significant cardiovascular events, have a lower treatment rate for heart defects, and are associated with a longer time before the patient’s renal function deteriorates. This translates into a continuing shift toward the dominion in terms of cardiometabolic protection – a strategy that is receiving strong backing from the majority of clinical guidelines across the world.