Figure 1. Current clinical and experimental hypothesis on cardioprotective effect of SGLT2 inhibitors.
| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
| Journal website http://www.jocmr.org |
Review
Volume 10, Number 8, August 2018, pages 615-625
SGLT-2 Inhibitors and Cardiovascular Protection: Lessons and Gaps in Understanding the Current Outcome Trials and Possible Benefits of Combining SGLT-2 Inhibitors With GLP-1 Agonists
Figure
Tables
| Clinical variable | Empagliflozin | Canagliflozin | Dapagliflozin | Liraglutide | Semaglutide | Pioglitazone |
|---|---|---|---|---|---|---|
| *Evidence from CVD real studies and not from CVOT-directed RCTs. | ||||||
| CV death | Reduced | Reduced | Neutral* | Reduced | Neutral | NA |
| Nonfatal MI | Neutral | Reduced | Neutral | Neutral | Neutral | Neutral |
| Nonfatal stroke | Neutral | Reduced | NA | Neutral | Reduced | Neutral |
| 3-point MACE | Reduced | Reduced | Reduced* | Reduced | Neutral | Reduced |
| All-cause mortality | Reduced | Reduced | Reduced* | Reduced | Neutral | Neutral |
| Hospitalization for heart failure | Reduced | Reduced | Reduced* | Neutral | Neutral | Neutral |
| New or worsening nephropathy | Reduced | Reduced | NA | Reduced | NA | NA |
| Retinopathy | NA | NA | NA | NA | Increased | NA |
| Adverse events | ||||||
| Bone fractures | Neutral | Increased | Neutral | NA | NA | Increased |
| Hypophosphatemia | Neutral | Increased | Increased | NA | NA | NA |
| Bone density changes | Neutral | Increased | Neutral | NA | NA | Reduced |
| Limp amputation | Neutral | Increased | Neutral | NA | NA | NA |
| DKA | Increased | Increased | Increased | NA | NA | NA |
| Genital infections | Increased | Increased | Increased | NA | NA | NA |
| Clinical variable | SGLT2i | GLP-1 agonists | CV risk improvement with combination SGLT2i and GLP-1 agonists |
|---|---|---|---|
| 3-point MACE | Reduced | Reduced | ++++ |
| BP | Reduced | Reduced | ++++ |
| Heart rate | Neutral | Increased | +/- |
| Fasting plasma glucose | Reduced | Reduced/neutral | ++ |
| Postprandial plasma glucose | Reduced | Reduced | ++++ |
| Dyslipidemia | Increased/reduced | Reduced | ++ |
| Insulin resistance | Reduced | Reduced | +++ |
| Systemic inflammation | Reduced | Reduced | ++++ |
| Vascular elasticity | Improved | Improved | ++++ |
| Heart muscle hypertrophy | Reduced | Reduced | ++ |
| Diuresis | Increased | Increased/neutral | +++ |
| Proteinuria | Reduced | Reduced | +++ |
| Hypermagnesemia | Increased | Neutral | ++ |
| Hyperketonemia | Increased | Neutral | ++ |
| CV effect appreciation | Started after 12 weeks only | Started at 12 months | Exert much more CV benefit at a more prolonged and sustained timeline |