Sécurité cardiovasculaire des agonistes du récepteur du glucagon-like peptide-1 et des inhibiteurs du co-transporteur sodium-glucose de type 2 : focus sur les résultats des grands essais d'intervention

In the last months, results from the EMPA-REG OUTCOME, LEADER, and SUSTAIN-6 studies provided strong arguments for a cardiovascular protective effect of SGLT2 inhibitors and long-acting GLP-1 receptor agonists. In these placebo-controlled trials conducted in type 2 diabetic subjects with previous history of cardiovascular diseases and/or associated risk factors, the incidence of major cardiovascular events was significantly reduced in patients that received empagliflozin, liragutide, or semaglutide. A significant decrease in cardiovascular and all-cause mortality was also reported with liraglutide and empagliflozin, as well as events related to heart failure with the latter. Beside their overall beneficial actions on associated cardiovascular risk factors, these molecules certainly exert cardiovascular protection through specific mechanisms that remain to be definitely identified. Finally, these trials also provided reassuring data in terms of tolerance profile and safety. Looking forward to the results from ongoing studies, it is doubtless premature to evoke a “class effect”, but the positive conclusions of these recent studies must bring us to urgently revise our therapeutic strategies in type 2 diabetes.