Cardiovascular Prevention and Pharmacotherapy

Review Articles

Sodium-glucose cotransporter 2 inhibitors in cardiocerebrovascular disease: Jin Joo Park; Cardiovasc Prev Pharmacother. 2024;6(4):103-108. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e16

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Abstract PDF: Cardiovascular disease is a leading cause of global mortality, necessitating effective strategies for prevention and treatment. The cardiovascular disease continuum concept highlights the progression from risk factors such as hypertension and diabetes mellitus to advanced stages, including heart failure (HF) and death. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed to manage diabetes, have emerged as effective therapies across all stages of the cardiovascular disease continuum. Numerous cardiovascular outcome trials demonstrate that SGLT2 inhibitors significantly reduce major adverse cardiovascular events and hospitalizations for HF in patients with and without established atherosclerotic cardiovascular disease. Notably, SGLT2 inhibitors have shown remarkable benefits in reducing HF risk, even in patients without diabetes, including those with HF and preserved ejection fraction. Furthermore, recent studies in post–myocardial infarction patients suggest potential benefits in reducing hospitalizations for HF. Despite their widespread use, the precise mechanisms by which SGLT2 inhibitors confer cardiovascular protection remain unclear, suggesting the need for further investigation. In conclusion, SGLT2 inhibitors have revolutionized cardiovascular disease management, offering significant therapeutic potential across a broad spectrum of patients, and are expected to play an increasingly prominent role in both the prevention and treatment of cardiovascular disease.

Paradigm shift from glucocentric to organ protection for the management of hyperglycemia in patients with type 2 diabetes: Jie-Eun Lee, Jong Chul Won; Cardiovasc Prev Pharmacother. 2024;6(4):116-122. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e15

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Abstract PDF: The UK Prospective Diabetes Study was the first study to investigate the effectiveness of glycemic control in patients with type 2 diabetes. Since then, many studies have evaluated the impact of intensive glycemic control on diabetes-related morbidities and mortality. The results of these studies were intended to change the paradigm for controlling glycated hemoglobin and preventing diabetes-related complications, but the beneficial outcomes were limited to microvascular diseases rather than diabetes-related cardiorenal diseases and deaths. This has emphasized the need for comprehensive management of other risk factors (hypertension, dyslipidemia, renal failure, etc.) in addition to hyperglycemia to prevent atherosclerotic cardiovascular diseases and end-stage renal disease in type 2 diabetes. Since 2008, clinical trials to demonstrate cardiovascular safety have shown a beneficial effect of sodium-glucose transporter 2 inhibitors or glucagon-like peptide-1 receptor agonists on macrovascular or renal complications in patients with type 2 diabetes. Recently, major societies around the world including the Korean Diabetes Association, have shifted the goals of diabetes management from the typical glucocentric view to cardiorenal outcome-oriented (organ protection) care, which has been widely accepted and is gradually applied to primary care.

Original Article

Effect of the addition of thiazolidinedione to sodium-glucose cotransporter 2 inhibitor therapy on lipid levels in type 2 diabetes mellitus: a retrospective study using Korean National Health Insurance Service data: Taegyun Park, Kyungdo Han, Dongwook Shin, Jongho Park; Cardiovasc Prev Pharmacother. 2022;4(3):114-122. Published online July 29, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e15

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Abstract PDF

Background
Dyslipidemia is common in patients with type 2 diabetes mellitus (T2D) and contributes to an increased risk of cardiovascular disease. Previous studies have shown that treatment with thiazolidinediones (TZDs) and sodium-glucose cotransporter-2 inhibitors (SGLT2-i) may help to improve dyslipidemia in T2D patients. In this study, we investigated whether patients treated with TZD and SGLT2-i showed greater improvement in high-density lipoprotein cholesterol (HDL-C) levels than those treated with only SGLT2-i.
Methods
From the National Health Insurance Service database of Korea, we extracted all patients who first received SGTL2-i from 2014 to 2016. Propensity score matching was performed to balance the two groups: group A (SGTL2-i and TZD, regardless of other antidiabetic medications) and group B (SGTL2-i only without TZD, regardless of other antidiabetic medications). Posttreatment HDL-C levels were compared by the Student t-test.
Results
In total, 1,400 T2D patients (700 in each group) were matched by propensity score matching. There was a significant posttreatment increase in HDL-C in group A (49.54±20.03 to 51.6±12.92 mg/dL, P=0.007), but not in group B (49.14±13.52 to 49.1±2.15 mg/dL, P=0.937). Group A also showed significantly higher posttreatment HDL-C levels than group B (51.4±12.92 vs. 49.1±12.15 mg/dL, P<0.001). Regarding the secondary endpoints, posttreatment triglyceride levels were lower (P<0.001), but total cholesterol (P=0.131) and low-density lipoprotein cholesterol levels (P=0.054) were not different after treatment.
Conclusions
The combination of SGTL2-i and TZD may be more effective in ameliorating dyslipidemia in T2D patients than SGLT2-i alone. However, further studies are needed to confirm this finding.

Citations

Citations to this article as recorded by

SGLT2 Inhibitor Use and Risk of Dementia and Parkinson Disease Among Patients With Type 2 Diabetes
Hae Kyung Kim, Geert Jan Biessels, Min Heui Yu, Namki Hong, Yong-ho Lee, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha, Eun Jig Lee, Minyoung Lee
Neurology.2024;[Epub] CrossRef
A Green Approach: Optimization of the UPLC Method Using DoE Software for Concurrent Quantification of Pioglitazone and Dapagliflozin in a SNEDDS Formulation for the Treatment of Diabetes
Ehab M. Elzayat, Abdelrahman Y. Sherif, Mohamed W. Attwa, Mohammad A. Altamimi
ACS Omega.2024; 9(45): 45011. CrossRef

Review Article

Paradigm Shift for the Treatment of Type 2 Diabetes Mellitus in Patients with Cardiovascular Disease: Cardiologist's Perspective: Doo Soo Jeon; Cardiovasc Prev Pharmacother. 2020;2(1):11-17. Published online January 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e4

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Abstract PDF: Type 2 diabetes mellitus (T2DM) is a complex disorder and is associated with an increased risk for developing atherosclerotic cardiovascular disease. Control of major risk factors of T2DM can reduce major adverse cardiovascular events (MACEs) in patients. Glycemic control has long been the gold standard for treatment of T2DM. However, strict blood glucose control strategies have repeatedly failed in the prevention of cardiovascular events in key clinical trials. The 2019 American and European practice guidelines for the prevention of cardiovascular disease in patients with T2DM have recommended the use of novel hypoglycemic agents, such as sodium glucose transporter 2 inhibitors and glucagonlike peptide-1 receptor antagonist, which have shown significant reductions in the risk of MACE in spite of their modest glycemic control capacity. A paradigm shift from the glucosecentered approach in treating diabetic patients with cardiovascular disease is imperative. Based on positive outcomes from previous evidence, the reduction of the risk of MACE should be a primary objective for treatment.

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