GLP-1 receptor agonists (GLP-1RAs) have rapidly evolved from antidiabetic drugs to cardiometabolic therapies with clinically proven reductions in hard cardiovascular endpoints – and increasingly beyond the traditional diabetes population. The mechanistic basis ranges from anti-atherogenic and endothelium-protective effects to anti-inflammatory and direct cardiac protective mechanisms to substantial weight reduction with favorable changes in blood pressure and lipids. The following article introduces the physiological basis, critically classifies the outcome evidence and discusses liraglutide, semaglutide (s.c. and oral), dulaglutide, albiglutide, efpeglenatide, exenatide and lixisenatide in a substance-specific manner. Dual and triple incretin concepts are outlined in perspective. Finally, safety, implementation and open questions for practice are discussed.
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