Antidiabetic drugs in cardioprotection: beyond glycemic control
DOI:
https://doi.org/10.22370/syc.1.1.2025.5395.Keywords:
myocardial infarction, Sodium-Glucose Transporter 2 Inhibitors, SemaglutideAbstract
Ischemic heart disease is the leading cause of cardiovascular mortality, with projections of up to 20 million deaths annually by 2050. These pathologies arise from the interruption of coronary blood flow (ischemia) followed by its restoration (reperfusion), a phenomenon that induces myocardial injury and left ventricular dysfunction. Ischemia/reperfusion (I/R) injury involves oxidative stress, intracellular calcium dysregulation, and microvascular damage, all of which exacerbate infarct size and promote the development of heart failure.
Despite current therapeutic approaches, there remains a critical need for strategies that effectively reduce myocardial injury. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown cardiovascular benefits beyond their glucose-lowering effects. Therefore, this review article aims to discuss the clinical and preclinical evidence related to the use of SGLT2 inhibitors and GLP-1 receptor agonists as cardioprotective agents, highlighting their potential therapeutic benefits and identifying the aspects that still require further elucidation.
SGLT2i, including empagliflozin and dapagliflozin, improve cardiovascular outcomes in heart failure independently of glycemic control, although their impact on myocardial infarction remains uncertain. Notably, semaglutide has demonstrated a significant reduction in major adverse cardiovascular events in obese non-diabetic patients, suggesting direct cardioprotective actions on the myocardium.
Preclinical studies indicate that these effects may involve both cardiomyocytes and endothelial cells, contributing to the preservation of cardiac function. Collectively, SGLT2i and GLP-1RA emerge as promising candidates for cardioprotection, although further clinical studies are required to elucidate their underlying mechanisms and optimize their translational efficacy.
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