Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been used to treat patients with type 2 diabetes since 2005 and have become popular because of the efficacy and durability in relation to glycaemic control in combination with weight loss in most patients. Today in 2022, seven GLP-1 RAs, including oral semaglutide are available for treatment of type 2 diabetes. Since the efficacy in relation to reduction of HbA1c and body weight as well as tolerability and dosing frequency vary between agents, the GLP-1 RAs cannot be considered equal. The short acting lixisenatide showed no cardiovascular benefits, while once daily liraglutide and the weekly agonists, subcutaneous semaglutide, dulaglutide, and efpeglenatide, all lowered the incidence of cardiovascular events. Liraglutide, oral semaglutide and exenatide once weekly also reduced mortality. GLP-1 RAs reduce the progression of diabetic kidney disease. In the 2019 consensus report from European Association for the Study of Diabetes/American Diabetes Association, GLP-1 RAs with demonstrated cardio-renal benefits (liraglutide, semaglutide and dulaglutide) are recommended after metformin to patients with established cardiovascular diseases or multiple cardiovascular risk factors. European Society of Cardiology suggests starting with a sodium-glucose cotransprter-2 inhibitor or a GLP-1 RA in drug naïve patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (CVD) or high CV Risk. However, the results from cardiovascular outcome trials (CVOT) are very heterogeneous suggesting that some GLP-1RAs are more suitable to prevent CVD than others. The CVOTs provide a basis upon which individual treatment decisions for patients with T2D and CVD can be made.

中文翻译：

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肠降血糖素的心血管作用：关注胰高血糖素样肽-1 受体激动剂

自 2005 年以来，胰高血糖素样肽-1 受体激动剂 (GLP-1 RAs) 已被用于治疗 2 型糖尿病患者，并且由于与大多数患者的血糖控制和体重减轻相关的疗效和持久性而变得流行起来。2022 年的今天，包括口服 semaglutide 在内的七种 GLP-1 RA 可用于治疗 2 型糖尿病。由于与降低 HbA1c 和体重相关的功效以及耐受性和给药频率因药物而异，因此不能将 GLP-1 RA 视为相等。短效利西拉来没有显示出心血管益处，而每天一次的利拉鲁肽和每周一次的激动剂皮下注射 semaglutide、dulaglutide 和 efpeglenatide 都降低了心血管事件的发生率。每周一次的利拉鲁肽、口服索马鲁肽和艾塞那肽也降低了死亡率。GLP-1 RA 可减少糖尿病肾病的进展。在欧洲糖尿病研究协会/美国糖尿病协会的 2019 年共识报告中，已证实患有心血管疾病或多种心血管危险因素的患者在使用二甲双胍后推荐使用 GLP-1 RA（利拉鲁肽、索马鲁肽和度拉鲁肽） . 欧洲心脏病学会建议，对于 2 型糖尿病 (T2D) 和动脉粥样硬化性心血管疾病 (CVD) 或高 CV 风险的未用药患者，从钠-葡萄糖协同转运蛋白 2 抑制剂或 GLP-1 RA 开始。然而，心血管结局试验 (CVOT) 的结果差异很大，表明某些 GLP-1RA 比其他 GLP-1RA 更适合预防 CVD。