Do cardiorenal therapies (RAASi, SGLT2i, GLP-1RA, and nonsteroidal MRAs) reduce cardiovascular risk beyond standard risk factor control in patients with diabetes and chronic kidney disease?
Cardiorenal therapies such as SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal MRAs provide additional cardiovascular risk reduction in patients with diabetes and CKD beyond standard metabolic and hemodynamic control.
Chronic kidney disease (CKD) and cardiovascular disease (CVD) have a significant inter-relationship in patients with diabetes. Controlling blood pressure, dyslipidemia, and glucose levels is a common treatment approach to managing CVD risk in patients with CKD and diabetes; despite strict control, however, a high residual risk remains. This review focuses on patients who require pharmacotherapy, in whom new and existing cardiorenal therapies (renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists) with differing mechanisms of action and safety profiles can reduce cardiovascular risk beyond the outcomes achieved with blood pressure, dyslipidemia, or glycemic control alone. Several treatment guidelines have been updated recently to reflect new evidence. Studies of these cardiorenal agents used in combination are ongoing, and results are awaited with interest, with the hope that potential synergistic effects may lead to further improvements in cardiovascular outcomes.
Morales et al. (Sat,) studied this question.