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


CONCLUSIONS
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.
Department of Internal Medicine I-Cardiology, University Hospital Aachen, RWTH Aachen, Germany.
M
M
Burgmaier
C
C
Heinrich
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N
Marx
D000818:Animals; D050197:Atherosclerosis / Q000209:etiology; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000209:etiology; D058065:Diabetic Cardiomyopathies / Q000188:drug therapy / Q000209:etiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D004285:Dogs; D004730:Endothelium, Vascular / Q000502:physiology; D052216:Glucagon-Like Peptide 1 / Q000502:physiology*; D000067757:Glucagon-Like Peptide-1 Receptor; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D051379:Mice; D009206:Myocardium / Q000378:metabolism; D009765:Obesity / Q000150:complications; D051381:Rats; D018027:Receptors, Glucagon / Q000037:antagonists & inhibitors*; D012307:Risk Factors; D013552:Swine
D054873:Dipeptidyl-Peptidase IV Inhibitors; C000593833:GLP1R protein, human; C000593834:Glp1r protein, mouse; C000593835:Glp1r protein, rat; D000067757:Glucagon-Like Peptide-1 Receptor; D007004:Hypoglycemic Agents; D018027:Receptors, Glucagon; D052216:Glucagon-Like Peptide 1