Cardiovascular-kidney-metabolic (CKM) syndrome is a novel concept that connects cardiovascular diseases, chronic kidney disease and diabetes. Scientific statement from the American Heart Association provides a CKM staging construct for prevention and care optimization within CKM syndrome from stage 0 (no CKM risk factors) to stage 4 (clinical CVD in CKM syndrome) and emphasized the optimal strategies for supporting lifestyle modification, targeting of emerging cardioprotective and kidney-protective therapies.
The cardioprotective therapies of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have revolutionized preventive care for individuals with diabetes. SGLT2is, originally developed as antidiabetic agents, are now known to prevent kidney failure and to have cardioprotective effects, most notably on heart failure-related hospitalizations and cardiovascular mortality. GLP-1RAs not only improve insulin resistance and glycemia but also reduce weight and cause significant reductions in the risk of major adverse cardiovascular events (MACE).
However, strategies for prioritizing the selection of SGLT2is or GLP-1RAs in the CKM syndrome are not well defined. Further data are urgently needed to guide prioritization of antihyperglycemic agents in patients with different stages of CKM syndrome.
Although recent studies have compared the effectiveness of SGLT2is versus GLP-1RAs on cardiovascular outcomes in patients with diabetes by emulating target trial, the effectiveness of these two drugs on cardiorenal outcome in different stages of CKM syndrome is lacking. Therefore, the aim of the project is to perform a target trial emulating to compare the effectiveness of SGLT2is versus GLP-1RAs on major adverse cardiovascular events and serious renal events in patients with CKM syndrome.
