SGLT2 inhibitors versus GLP-1 receptor agonists in cardiovascular protection in patients with type 2 diabetes mellitus

Abstract

Type 2 diabetes mellitus is associated with high cardiovascular morbidity and mortality, with cardiovascular disease being one of the leading causes of death in this population. In recent years, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) have emerged as important therapeutic strategies capable of promoting cardiovascular, renal, and metabolic benefits beyond glycemic control. The present study aimed to compare the cardiovascular effects of SGLT2 inhibitors and GLP-1 receptor agonists through a narrative literature review. The bibliographic search was conducted in the PubMed, Scopus, Web of Science, and Google Scholar databases, initially identifying 27 relevant studies, of which 8 were selected after applying the eligibility criteria. The analyzed studies demonstrated that both drug classes significantly reduce major adverse cardiovascular events in patients with type 2 diabetes mellitus. However, GLP-1 receptor agonists showed greater impact on weight loss, glycemic control, and reduction of atherosclerotic events, especially stroke. On the other hand, SGLT2 inhibitors demonstrated more expressive benefits in heart failure, reduction of hospitalization rates, and renal protection. Furthermore, recent evidence suggests a possible complementary effect between both therapeutic classes when used in combination. It is concluded that both SGLT2 inhibitors and GLP-1 receptor agonists represent fundamental pillars in modern cardiometabolic treatment, and their choice should be individualized according to the clinical characteristics and therapeutic goals of each patient.