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Abstract
According to the American Diabetes Association (ADA) and the European Association for the Study of Diabetes guideline for treatment of diabetes, glucagon-like peptide-1 receptor agonist (GLP-1 RA) is recommended in diabetic patients with established atherosclerotic cardiovascular disease. This recommendation is based on the results of recent cardiovascular outcome trials of this kind of medications. GLP-1 RAs have a glucose lowering effect with weight loss and a lower incidence of hypoglycemia, and can improve cardiovascular outcomes such as three-point major cardiovascular events composed of death from cardiovascular causes, non-fatal myocardial infarction, and non-fatal stroke. Also, several GLP-1 RAs have beneficial effects on renal outcomes, mainly due to improvement in macroalbuminuria. In addition, high-dose liraglutide (3 mg/day subcutaneous injection) showed efficacy for reducing body weight. Therefore GLP-1 RA may be effective in patients with established cardiovascular disease, chronic kidney disease, and/or metabolic syndrome.
Figures and Tables
Table 1
Comparison of GLP-1 RAs in prospective cardiovascular studies
The data are expressed as hazard ratio (95% confidence interval). All causes mortality in exenatide was not considered to be statistically significant on the basis of the hierarchical testing plan [26].
GLP-1 RA, glucagon-like peptide-1 receptor agonist; ELIXA, The Evaluation of Lixisenatide in Acute Coronary Syndrome; LEADER, The Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results; EXSCEL, The Exenatide Study of Cardiovascular Event Lowering; SUSTAIN-6, The Preapproval Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes; HARMONY, albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease; REWIND, dulaglutide and cardiovascular outcomes in type 2 diabetes; 3P MACE, three-point major adverse cardiovascular events; 4P MACE, four-point major adverse cardiovascular events; CV, cardiovascular; MI, myocardial infarction; HHF, hospital admission for heart failure.
aIncludes both fatal and non-fatal MI.
bIncludes both fatal and non-fatal stroke.
cNew-onset persistent macroalbuminuria, or persistent doubling of serum creatinine level and creatinine clearance per MDRD < 45 mL/min/1.73 m2, or the need for continuous renal replacement therapy (in the absence of an acute reversible cause) or death due to renal disease.
dNew or worsening nephropathy includes persistent macroalbuminuria, persistent doubling of serum creatinine level and creatinine clearance of less than 45 ml per minute per 1.73 m2 of body-surface area (according to the Modification of Diet in Renal Disease criteria), or the need for continuous renal-replacement therapy.
eNew macroalbuminuria, a sustained decline in estimated glomerular filtration rate of 30% or more from baseline, or chronic renal replacement therapy.
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