Vascular failure and recent anti-diabetic drugs

Type 2 diabetes mellitus (T2DM) is highly prevalent and is a critical risk factor for cardiovascular (CV) disease, increasing both morbidity and mortality. T2DM is one of the most important classical CV risk factors that promote atherosclerosis. Therefore, it is important for both patients with T2DM and their doctors to identify vascular dysfunction at an early stage of atherosclerosis. Recently, new therapies based on the actions of the incretin hormones and blockade of sodium glucose transporter (SGLT) 2 have become widely used, because they offer advantages over conventional treatments by achieving glycemic control and/or possible reducing CV risks. Many experimental studies have suggested that glucagon-like peptide (GLP)-1 and dipeptidyl peptidase (DPP)-4 inhibitors exert cardioprotective effects on atherosclerosis and cardiac dysfunction both in vitro and in vivo. However, thus far, there is little clinical evidence supporting the efficacy of incretin therapy in patients with CV disease. In contrast, the SGLT2 inhibitor empagliflozin achieved a remarkable reduction in CV-related mortality in a large clinical study. The present review focuses on the effects of GLP-1-related therapies and SGLT2 inhibitors on clinical indices of endothelial function.