Modern glucose-lowering drugs SGLT2 inhibitors and GLP-1 agonists in the prevention of cardiovascular disease and dementia in patients with diabetes and metabolic disorders

Cardiovascular diseases (CVD) and dementia are two leading causes of mortality and disability in the aging population, and their shared metabolic foundation (insulin resistance, chronic inflammation, and vascular dysfunction) opens new opportunities for pharmacological prevention. Modern glucose-lowering drugs, i.e. sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors, gliflozins) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), demonstrate pleiotropic effects that extend far beyond glycemic control. Meta-analyses and large cohort studies in recent years confirm their cardio- and renoprotective efficacy, and also point to their potential in reducing the risk of Alzheimer's disease and vascular dementia. The greatest benefit is expected in patients with concomitant cardiovascular and cerebrovascular disease, though definitive confirmation of neuroprotective effects awaits the completion of large randomized trials. This article presents a clinical pharmacological analysis of current data, discussing the mechanisms of action, clinical efficacy, safety, and strategies for personalized use of SGLT2 inhibitors and GLP-1 RAs in preventing cardiovascular and neurodegenerative complications in patients with type 2 diabetes and metabolic disorders.