Tinizhañay-Peralta, Viviana B

ABSTRACT

In recent years, new antidiabetic drugs have emerged, such as GLP-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and dipeptidyl peptidase-4 inhibitors, which have gained relevance for offering benefits beyond glycemic control, especially in cardiovascular and renal protection. In this context, it is pertinent to examine their potential role in cardiac surgery. The manuscript aims to describe and analyze the positive and negative impact of these therapies on cardiovascular and renal outcomes in patients undergoing cardiac surgery, regardless of the presence of diabetes mellitus. A systematic search is conducted in PubMed, Scopus, and the Cochrane Library for studies published between 2020 and 2025. Studies evaluating the safety and efficacy of GLP-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and dipeptidyl peptidase-4 inhibitors, and dipeptidyl peptidase-4 inhibitors were included. The outcomes analyzed are perioperative safety, glycemic control, cardiovascular complications, and renal function. GLP-1 receptor agonists improved perioperative glycemic control, reduced insulin requirements, and promoted cardiac recovery, without increasing hypoglycemia or serious adverse events. Sodium-glucose cotransporter 2 inhibitors demonstrated cardioprotective and nephroprotective effects, with a lower incidence of acute kidney injury, reduced inflammatory markers, and improved outcomes after coronary artery bypass grafting. In contrast, the evidence on dipeptidyl peptidase-4 inhibitors was inconsistent, with inconclusive benefits and even a possible risk of organ dysfunction. In summary, GLP-1 receptor agonists and odium-glucose cotransporter 2 inhibitors are emerging as safe and promising options in cardiac surgery, while routine use of dipeptidyl peptidase-4 inhibitors is not recommended due to limited and controversial evidence.

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