Key result
SGLT2 inhibitors favor HF and CKD outcomes, whereas GLP-1 agonists better reduce weight and ASCVD.
Why the study?
Comparative assessment of cardiovascular and kidney benefits of SGLT-2 inhibitors versus GLP-1 receptor agonists in high cardiovascular risk type 2 diabetes patients is complicated by absence of adequately powered head-to-head randomized trials.
Selection between SGLT-2 inhibitors and GLP-1 receptor agonists should be tailored to the patient's specific cardiometabolic phenotype, prioritizing SGLT-2 inhibitors for heart failure or chronic kidney disease, and GLP-1 receptor agonists for atherosclerotic risk and weight reduction.
Supports individualized SGLT-2 inhibitor or GLP-1 agonist selection by dominant risk; leaves open confirmation by direct head-to-head RCTs.
Cardiovascular disease remains the principal determinant of morbidity, premature mortality, and healthcare utilization among patients with type 2 diabetes mellitus. Over the past decade, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists have transformed glucose-lowering therapy by demonstrating cardiovascular and kidney benefits that extend beyond glycemic control. Although both drug classes are recommended for patients with established atherosclerotic cardiovascular disease or multiple cardiovascular risk factors, their clinical effects are not interchangeable. Sodium-glucose cotransporter-2 inhibitors produce early and consistent reductions in hospitalization for heart failure and progression of chronic kidney disease, whereas glucagon-like peptide-1 receptor agonists exert more pronounced effects on body weight, atherosclerotic cardiovascular events, and particularly stroke prevention. The absence of adequately powered head-to-head randomized cardiovascular outcome trials complicates direct therapeutic comparisons. Consequently, comparative assessment currently depends on indirect comparisons of placebo-controlled cardiovascular outcome trials, network meta-analyses, observational cohorts, administrative databases, and target-trial emulation studies. This narrative review evaluates the comparative effectiveness of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus at high cardiovascular risk. Particular attention is given to major adverse cardiovascular events, myocardial infarction, stroke, cardiovascular mortality, heart failure hospitalization, kidney outcomes, metabolic effects, safety, treatment adherence, and patient selection. The review also considers biological mechanisms that may explain the different clinical profiles of these agents, including natriuresis, restoration of tubuloglomerular feedback, modulation of myocardial energetics, weight reduction, attenuation of vascular inflammation, and improvement of endothelial function. https://doi.org/10.52783/jchr.v16.i4.15645
No takes yet. Share an insight, caveat, or question.
Knizhenko Egor (2026) conducted a review in Type 2 diabetes mellitus at high cardiovascular risk. SGLT-2 inhibitors and GLP-1 receptor agonists was evaluated. SGLT-2 inhibitors provide consistent reductions in heart failure hospitalization and chronic kidney disease progression, whereas GLP-1 receptor agonists exert stronger effects on weight loss and atherosclerotic events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: