What Clinicians Need to Know About the Cardiovascular Effects of the Most Recent Classes of Drugs Used for Type 2 Diabetes

The treatment of cardiovascular disease in patients with diabetes has seen a sea change in recent years with the development of novel antihyperglycemic agents. The impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), two medication classes introduced in the United States in the wake of increased scrutiny by the US Food and Drug Administration on cardiovascular disease and antihyperglycemic agents, highlight this progression. In recent trials, SGLT2 inhibitors have demonstrated significant reductions in admissions for heart failure in patients with established cardiovascular disease and those at risk of cardiovascular disease, as well as significant reductions in major adverse cardiovascular events for those with established cardiovascular disease. GLP-1 RAs have exhibited consistent reductions in major adverse cardiovascular events for patients with established cardiovascular disease. These developments have led the 2019 American Diabetes Association guidelines to recommend considering each patient's cardiovascular history when selecting antihyperglycemic agents. The goal of this article is to review recent updates and provide relevant strategies for providers on SGLT2 and GLP-1 RAs in treating cardiovascular disease in patients with diabetes.