Cardiovascular Outcomes in Trials of New Antidiabetic Drug Classes

Card Fail Rev. 2021 Mar 5:7:e04. doi: 10.15420/cfr.2020.19. eCollection 2021 Mar.


Type 2 diabetes is among the most prevalent chronic diseases worldwide and the prevention of associated cardiovascular complications is an important treatment goal. Sodium-glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are second-line options after metformin, while cardiovascular outcome trials have been conducted to establish the cardiovascular safety of these antidiabetic drug classes. SGLT2 inhibitors have been shown to have the best overall mortality, renal and cardiovascular outcomes. Reduction in hospitalisation for heart failure is particularly consistent. GLP-1 receptor agonists have also showed some benefits, especially in stroke prevention. DPP-4 inhibitors showed neutral effects on cardiovascular outcomes, but may increase the incidence of heart failure. Favourable outcomes observed in trials of SGLT2 inhibitors mean that these should be the preferred second-line option. DPP-4 inhibitors are useful for patients with diabetes at low cardiovascular risk.

Keywords: Antidiabetic drug; cardiovascular outcome; dipeptidyl peptidase-4 inhibitor; glucagon-like peptide 1 receptor agonist; heart failure; mortality; renal outcomes; sodium–glucose co-transporter 2 inhibitor; stroke; type 2 diabetes.

Publication types

  • Review