Diabetes and cardiovascular disease: from new mechanisms to new therapies

Diabetes increases the risk of cardiovascular diseases, which are the leading cause of mortality among diabetic patients. Although hyperglycemia is a major determinant of macrovascular and microvascular complications in diabetes, hypoglycemia and glycemic variability have also a strong influence on the cardiovascular system. This overview presents the current state of knowledge on the impact of type 2 diabetes on the cardiovascular system and new therapeutic strategies that have been recently developed to correct gluco-metabolic disturbances in patients with high cardiovascular risk, such as glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium–glucose cotransporter 2 (SGLT2) inhibitors. Results of several large randomized clinical trials (such as EMPA-REG, LEADER, SUSTAIN-6 and CANVAS) assessing the efficacy and safety of drugs based on new mechanisms deserve attention due to their beneficial impact on serious cardiovascular events, including cardiovascular death, myocardial infarction, and stroke. In addition, based on the results of recent studies and meta-analyses, an attempt was made to answer the questions of whether actions new drugs are mediated solely by the glucose lowering effect, and if indeed glycemic control affects the survival of patients with diabetes and cardiovascular risk, which seems of key importance from the clinical perspective.