Managing glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in clinical practice
The obesity epidemic has heightened the impact of cardiometabolic risk factors on cardiovascular and kidney disease. GLP-1 receptor agonists (GLP-1RAs) and SGLT2 inhibitors (SGLT2is), originally developed for type 2 diabetes, reduce cardiovascular and renal risk in randomised trials. SGLT2is are the first class proven to improve prognosis in heart failure with preserved ejection fraction (HFpEF), and evidence is accumulating that GLP-1RAs may also help there. Notably, the benefits are independent of diabetes status and baseline renal function. This practice-oriented review discusses how to use these drugs in everyday care for patients at high cardiovascular and renal risk, in line with evolving guidelines.
Summary
The obesity epidemic has significantly heightened the impact of cardiometabolic risk factors on the global burden of cardiovascular and kidney diseases. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is), originally developed for type 2 diabetes treatment, have demonstrated in randomised controlled trials their ability to reduce the risk of cardiovascular and kidney diseases. This has led to substantial improvements in patient outcomes. SGLT2i, in particular, are the first class of drugs proven to improve the prognosis of patients with heart failure with preserved ejection fraction, and evidence is accumulating to suggest that also GLP-1RA might be beneficial in these patients. Remarkably, the benefits of GLP-1RA and SGLT2i are independent of type 2 diabetes status or baseline renal function. The critical role of these drug classes in managing high cardiovascular risk patients is increasingly acknowledged in guidelines, which
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