Cardiovascular, renal, and cerebral protection by SGLT2. Hemodynamic, tissular, and cellular mechanisms involved

Abstract

After many years of looking for new mechanisms and strategies for cardiovascular and renal protection, sodium-glucose co-transport inhibitors or gliflozins appeared, demonstrating not only a notable and unexpected protective effect on various organ lesions: heart, arteries, kidneys, and brain but also an impressive event reduction. These effects were initially associated with better control of metabolic diseases such as diabetes. However, with time and the results, functional and structural improvements in said organs were verified in people without diabetes. These improvements went beyond the responses initially sought and extended to hemodynamic aspects and the benefits on cellular and subcellular structures and functions associated with protection in various tissues. These facts allow us to understand the notable reduction of the various events seen in the patients, including a reduction in mortality of around 30%. This review will show the existing evidence in renal, cardiovascular, and brain protection that translates into notable changes in clinical practice guidelines. We will also review cellular mechanistic knowledge, particularly improving mitochondrial function, which leads to less oxidative stress and inflammation. In summary, the review explains at least part of the reasons for these drugs nowadays to occupy the first line of treatment for cardiovascular and renal diseases. Finally, we will give reasons suggesting that gliflozins can be used in the future to prevent highly prevalent diseases.