Patients with type 2 diabetes are at high risk for development of cardiovascular disease, including myocardial infarction, stroke, heart failure, and cardiovascular death. Multiple large cardiovascular outcome trials with novel glucose-lowering agents, namely SGLT2i (SGLT2 inhibitors) and GLP-1 RA (GLP-1 receptor agonists), have demonstrated robust and significant reductions of major adverse cardiovascular events and additional cardiovascular outcomes, such as hospitalizations for heart failure. This evidence has changed the landscape for treatment of patients with type 2 diabetes. Both diabetes and cardiology guidelines and professional societies have responded to this paradigm shift by including strong recommendations to use SGLT2i and/or GLP-1 RA, with evidence-based benefits to reduce cardiovascular risk in high-risk individuals with type 2 diabetes, independent of the need for additional glucose control. GLP-1 RA were initially developed as glucose-lowering drugs because activation of the GLP-1 receptor by these agents leads to a reduction in blood glucose and an improvement in postprandial glucose metabolism. By stimulating GLP-1R in hypothalamic neurons, GLP-1 RA additionally induce satiety and lead to weight loss. Data from cardiovascular outcome trials demonstrated a robust and consistent reduction in atherothrombotic events, particularly in patients with established atherosclerotic cardiovascular disease. Despite the consistent evidence of atherosclerotic cardiovascular disease benefit from these trials, the number of patients receiving these drugs remains low. This overview summarizes the experimental and clinical evidence of cardiovascular risk reduction offered by GLP-1 RA, and provides practical information on how these drugs should be implemented in the treatment of type 2 diabetes in the cardiology community.

中文翻译：

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GLP-1 受体激动剂用于降低 2 型糖尿病患者的动脉粥样硬化心血管风险

2 型糖尿病患者发生心血管疾病的风险很高，包括心肌梗塞、中风、心力衰竭和心血管死亡。使用新型降糖药（即 SGLT2i（SGLT2 抑制剂）和 GLP-1 RA（GLP-1 受体激动剂））进行的多项大型心血管结果试验表明，主要心血管不良事件和其他心血管结果（如住院）的稳健和显着减少用于心力衰竭。这一证据改变了 2 型糖尿病患者的治疗前景。糖尿病和心脏病学指南以及专业协会都通过强烈建议使用 SGLT2i 和/或 GLP-1 RA 来应对这种范式转变，具有基于证据的益处，可以降低 2 型糖尿病高危人群的心血管风险，而无需额外的血糖控制。GLP-1 RA 最初是作为降糖药物开发的，因为这些药物激活 GLP-1 受体会降低血糖并改善餐后葡萄糖代谢。通过刺激下丘脑神经元中的 GLP-1R，GLP-1 RA 还会引起饱腹感并导致体重减轻。来自心血管结局试验的数据表明，动脉粥样硬化血栓形成事件显着且持续减少，尤其是在患有已确诊的动脉粥样硬化性心血管疾病的患者中。尽管有一致的证据表明动脉粥样硬化性心血管疾病可从这些试验中获益，但接受这些药物治疗的患者人数仍然很少。