The role of sodium-glucose cotransporter type 2 inhibitors on the path to cardiovascular well-being in type 2 diabetes mellitus and chronic kidney disease

Abstract

SGLT-2 inhibitors first emerged as a new class of oral hypoglycemic drugs with modest efficacy in lowering HbA 1c levels, which were also capable of inducing weight loss and lowering blood pressure without a significant risk of hypoglycemia. However, an analysis of the results of studies conducted to assess cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) during iSGLT-2 therapy showed evidence of nephroprotection, which led to the initiation of trials on renal outcomes. The data obtained showed that the protective effects of iSGLT-2 against cardiovascular and renal complications of type 2 diabetes do not directly depend on their hypoglycemic activity, while their particular clinical significance is demonstrated in reducing the risk of hospitalization for heart failure (HF), progression of diabetic kidney disease (RDK), as well as a reduction in the incidence of major adverse cardiovascular events (MACE).Today it is known that against the background of diabetic nephropathy, cardiovascular consequences become more serious. CKD patients with diabetes are more likely to die from cardiovascular causes than from end-stage renal disease. Diabetic kidney disease appears to be not only a marker of increased cardiovascular risk, but also involved in the pathogenesis of cardiovascular disease. An increase in traditional risk factors such as hypertension, hyperlipidemia, and obesity cannot fully explain the worse cardiovascular and fatal outcomes in CKD.This review will focus on the role of iSGLT-2 in the outcomes of type 2 DM complicated by the development of CKD, and will highlight the putative mechanisms of the nephroprotective action of this group of drugs.