Type 2 diabetes mellitus (T2DM) is a rapidly evolving global health issue associated with a
markedly increased risk of cardiovascular (CV) morbidity and mortality. The hyperglycaemic milieu
contributes to the development of CV complications via several pathological pathways, leading to increased
arterial stiffness (AS), that can be considered as a predictor of CV events in patients with diabetes.
The measurement of AS is increasingly used for the clinical assessment of patients. Several methodologies
were used in extensive population studies to assess AS; the most commonly used is the pulse
wave velocity (PWV). The cardio-ankle vascular index (CAVI) was developed to measure AS; it is not
affected by blood pressure at the time of measurement and shows stable values in healthy persons for
years. There are several potential pharmacological and non-pharmacological interventions aiming to
reduce AS. Recent evidence from clinical trials suggests that newer antidiabetic drugs do not only exert
glycaemic-lowering properties but also decrease CV risk. In this context, sodium glucose cotransporter-
2 inhibitors (SGLT2i) ( empagliflozin, canagliflozin and dapagliflozin) significantly reduced the risk of
CV and all-cause mortality (only EMPA-REG OUTCOME study) and hospitalization for heart failure in
patients with T2DM with established CV disease and/or with CV risk factors. Improved endothelial
function and AS probably represents one of the mechanisms by which these drugs exert their beneficial
effects. The present review aimed both to describe the association between AS and T2DM and to discuss
the effectiveness of SGLT2i on vascular endothelial dysfunction and AS.
Keywords: Arterial stiffness, canagliflozin, cardiovascular disease, dapagliflozin, diabetes mellitus, empagliflozin, sodium
Wight T. The vascular extracellular matrix. Philadelphia, PA: Lippincott-Raven 1996.
O’Rourke MF. Principles and definitions of arterial stiffness, wave reflections and pulse pressure amplification. In: Handbook of hypertension Elsevier. 2006; 23: pp. 3-20.
Hasegawa M. Fundamental research on human aortic pulse wave velocity. Jikeikai Med J 1970; 85: 742-60.
Hasegawa M, Arai C. Clinical estimation of vascular elastic function and practical application. Connect Tissue 1995; 27: 149-57.
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