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The Role of SGLT-2 Inhibitors as Part of Optimal Medical Therapy in Improving Cardiovascular Outcomes in Patients with Diabetes and Coronary Artery Disease

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Abstract

The optimal treatment approach to patients with coronary artery disease (CAD), including those with type 2 diabetes mellitus (T2DM), has been extensively evaluated. Several trials of stable ischemic heart disease including patients with T2DM have demonstrated that medical management is comparable to revascularization in terms of mortality and rates of major adverse cardiovascular events (MACE). There has been a growing appreciation for optimal medical therapy’s (OMT) role in improving clinical outcomes. It is vital to target T2DM patients to prevent or delay MACE events through advanced OMT, ultimately delaying if not avoiding the need for revascularization. There has been significant evolution in the development of pharmacologic management of T2DM patients. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a new pharmacologic therapy with tremendous potential to alter clinical practice and influence practice guidelines. SGLT2-inhibitors have great potential in reducing MACE in patients with T2DM and CAD. Empagliflozin should be considered as a part of OMT among these patients. If results similar to the EMPA-REG OUTCOMES trial are replicated in other trials, the use of these pharmacologic agents as a part of OMT may narrow the gap between revascularization and OMT alone in patients with T2DM and multi-vessel disease. Future studies on the role of SLGT-2 inhibitors with regard to heart failure outcomes are needed to elucidate the mechanisms and clinical effects in this vulnerable population.

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Authors and Affiliations

  1. University at Buffalo, State University of New York, Buffalo, NY, USA

    Wassim Mosleh, Brian Page & Umesh C. Sharma

  2. Duke Clinical Research Institute, Duke University, Durham, NC, USA

    Abhinav Sharma

  3. Department of Medicine, Albany Medical College, Albany Medical Center, Albany, NY, USA

    Mandeep S. Sidhu

  4. Peter Munk Cardiac Centre, University Health Network, 585 University Avenue, 4N474, Toronto, ON, M5G 2N2, Canada

    Michael E. Farkouh

  5. The Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada

    Michael E. Farkouh

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  1. Wassim Mosleh
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Correspondence to Michael E. Farkouh.

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AS has received research grants from the Bayer-Vascular Canadian Cardiovascular Society research grant, the Alberta Innovates Health Solution Clinician Scientist fellowship, Takeda, and Roche Diagnostics. All other authors listed declare that they have no conflict of interest.

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Mosleh, W., Sharma, A., Sidhu, M.S. et al. The Role of SGLT-2 Inhibitors as Part of Optimal Medical Therapy in Improving Cardiovascular Outcomes in Patients with Diabetes and Coronary Artery Disease. Cardiovasc Drugs Ther 31, 311–318 (2017). https://doi.org/10.1007/s10557-017-6729-y

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