Cardiovascular Disease Management With Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Cardiology Primer

Authors

Allan Zhang
Ramsey Kalil
Alexander Marzec
Stephanie A Coulter
Salim Virani
Kershaw V Patel
Matthew W Segar

Publication Date

4-9-2024

Journal

The Texas Heart Journal

DOI

10.14503/THIJ-23-8375

PMID

38590152

PMCID

PMC11075510

PubMedCentral® Posted Date

4-9-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Cardiology, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glucose, Hypoglycemic Agents, Sodium, Sodium-Glucose Transporter 2 Inhibitors, Diabetes mellitus, cardiovascular diseases, hypoglycemic agents, sodium-glucose transporter 2 inhibitors, glycemic control, heart failure, atherosclerosis

Abstract

Patients with type 2 diabetes face an elevated risk of cardiovascular disease. This review centers on sodium-glucose cotransporter-2 (SGLT2) inhibitors, a class of drugs that, according to a growing body of evidence, may have major potential for managing cardiovascular disease in patients with type 2 diabetes. This review presents findings from multiple clinical trials suggesting that SGLT2 inhibitors can not only serve as preventive therapeutic agents but also play a role in the active management of heart failure. The discussion includes the mechanism of action of SGLT2 inhibitors, emphasizing that they enhance urinary glucose excretion, which could lead to improved glycemic control and contribute to metabolic shifts beneficial to cardiac function. Alongside these cardiometabolic effects, safety concerns and practical considerations for prescribing these agents are addressed, taking into account potential adverse effects such as genitourinary infections and diabetic ketoacidosis as well as the financial implications for patients. Despite these drawbacks, therapeutic indications for SGLT2 inhibitors continue to expand, including for kidney protection, although further research is necessary to fully understand the mechanisms driving the cardioprotective and kidney-protective effects of SGLT2 inhibitors. By synthesizing current knowledge, this review intends to inform and guide clinical decision-making, thereby enhancing cardiovascular disease outcomes in patients with type 2 diabetes.