GLP-1-based therapies and SGLT2 inhibitors demonstrate potential beneficial effects on the myocardial microvascular compartment in patients with diabetes mellitus.
Do GLP-1 based therapies and SGLT2 inhibitors improve coronary microvascular dysfunction in patients with diabetes mellitus?
This review highlights the potential of GLP-1 receptor agonists and SGLT2 inhibitors to target coronary microvascular dysfunction in patients with diabetes.
Diabetic patients are frequently affected by coronary microvascular dysfunction (CMD), a condition consisting of a combination of altered vasomotion and long-term structural change to coronary arterioles leading to impaired regulation of blood flow in response to changing cardiomyocyte oxygen requirements. The pathogenesis of this microvascular complication is complex and not completely known, involving several alterations among which hyperglycemia and insulin resistance play particularly central roles leading to oxidative stress, inflammatory activation and altered barrier function of endothelium. CMD significantly contributes to cardiac events such as angina or infarction without obstructive coronary artery disease, as well as heart failure, especially the phenotype associated with preserved ejection fraction, which greatly impact cardiovascular (CV) prognosis. To date, no treatments specifically target this vascular damage, but recent experimental studies and some clinical investigations have produced data in favor of potential beneficial effects on coronary micro vessels caused by two classes of glucose-lowering drugs: glucagon-like peptide 1 (GLP-1)-based therapy and inhibitors of sodium-glucose cotransporter-2 (SGLT2). The purpose of this review is to describe pathophysiological mechanisms, clinical manifestations of CMD with particular reference to diabetes, and to summarize the protective effects of antidiabetic drugs on the myocardial microvascular compartment.
Salvatore et al. (Wed,) conducted a review in Coronary Microvascular Dysfunction in Diabetes Mellitus. GLP-1-based therapy and SGLT2 inhibitors was evaluated. GLP-1-based therapies and SGLT2 inhibitors demonstrate potential beneficial effects on the myocardial microvascular compartment in patients with diabetes mellitus.