Cardiovascular effects of GLP-1 and GLP-1-based therapies: implications for the cardiovascular continuum in diabetes?

Diabet. Med. 30, 289–299 (2013) Aims Glucagon‐like peptide‐1 receptor agonists and inhibitors of dipeptidyl peptidase‐4 that increase glucagon‐like peptide‐1 plasma concentrations are current treatment options for patients with diabetes mellitus. As patients with diabetes are a high‐risk population for the development of a severe and diffuse atherosclerosis, we aim to review the potential action of these drugs on cardiovascular disease and to summarize the potential role of present glucagon‐like peptide‐1‐based therapies from a cardiologist’s point of view. Methods Using a PubMed/MEDLINE search without language restriction, studies were identified and evaluated in order to review the effects of glucagon‐like peptide‐1‐based therapy on different stages of the cardiovascular continuum. Results Recent experimental as well as clinical data suggest that dipeptidyl peptidase‐4 inhibitors and glucagon‐like peptide‐1 receptor agonists—in addition to their metabolic effects—may have beneficial effects on the cardiovascular continuum at multiple stages, including: (1) cardiovascular risk factors; (2) molecular mechanisms involved in atherogenesis; (3) ischaemic heart disease; and (4) heart failure. Furthermore, retrospective analysis suggested decreased cardiovascular events in patients with glucagon‐like peptide‐1‐based therapies. Conclusion There are ample data to suggest beneficial effects of glucagon‐like peptide‐1‐based therapies on the cardiovascular continuum and large‐scale clinical trials are warranted to determine whether these effects translate into improved cardiovascular endpoints in humans.