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From glucose lowering to treatment of cardiovascular disease: the repositioning of glucose-lowering agents

Commented by Massimiliano Caprio, Cristiana Vitale, Giuseppe M C Rosano


This editorial refers to ‘Glucagon-like peptide-1 receptor agonists and the risk of cardiovascular events in diabetes patients surviving an acute myocardial infarction’, by M. Trevisan et al.

Altered glucose metabolism is a frequent finding in patients with coronary artery disease. Nearly 30% of patients with acute coronary syndromes have known diabetes mellitus (DM) and, when investigated, up to 70% of the remainder are found to have either DM or impaired glucose metabolism.

Early studies had suggested that glucose control improves prognosis in acute coronary syndromes. However, these early data have not been fully confirmed by subsequent studies. The DIGAMI study reported that intensified glycaemic control with insulin reduced mortality by 25% in DM patients with an acute myocardial infarction

The recent evidence suggests that an early treatment with a GLP-1 RA or an SGLT2i in DM patients after an acute coronary event may be beneficial and determine higher CV benefit. However, whereas the effects of SGLT2 inhibition with dapagliflozin in patients with heart failure have been unequivocally proven in the DAPA-HF study, the possible effects of GLP-1 RAs in patients with an MI still need to be proven in ad hoc studies. Notably, dapagliflozin demonstrated a clear prognostic benefit in heart failure regardless of the presence of DM, suggesting that at the present dapagliflozin (no evidence for emagliflozin, canagliflozin and ertugliflozin at the present) should be regarded as a CV drug. Should such evidence be demonstrated also for GLP-1 RAs, we will then have another new class of cardio-metabolic drugs.


European Heart Journal - Cardiovascular Pharmacotherapy, Volume 7, Issue 2, March 2021, Pages 83–85

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.