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Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2026, Número 1

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Cir Card Mex 2026; 11 (1)


Agentes antidiabéticos de nueva generación en cirugía cardíaca: beneficios cardiovasculares y renales más allá del control glucémico

Tinizhañay-Peralta VB

Idioma: Portugués
Referencias bibliográficas: 31
Paginas: 13-19
Archivo PDF: 587.66 Kb.


RESUMEN

En los últimos años han surgido nuevos fármacos antidiabéticos, como los agonistas del receptor de GLP1, los inhibidores del cotransportador sodio-glucosa tipo 2 y los inhibidores de la dipeptidil peptidasa-4, que han cobrado relevancia por ofrecer beneficios más allá del control glucémico, especialmente en la protección cardiovascular y renal. En este contexto, resulta pertinente examinar su papel potencial en la cirugía cardíaca. El objetivo de la presente revisión es describir y analizar el impacto positivo y negativo de estas terapias sobre los resultados cardiovasculares y renales en pacientes sometidos a cirugía cardíaca, independientemente de la presencia de diabetes mellitus. Se emplea una búsqueda sistemática en PubMed, Scopus y Cochrane Library de estudios publicados entre 2020 y 2025. Se incluyeron estudios que evaluaron la seguridad y eficacia de agonistas del GLP1, inhibidores del SGLT2 e inhibidores de DPP4. Los desenlaces analizados son seguridad perioperatoria, control glucémico, complicaciones cardiovasculares y función renal. Los agonistas del GLP1 mejoraron el control glucémico perioperatorio, redujeron los requerimientos de insulina y favorecieron la recuperación cardíaca, sin aumentar hipoglucemias ni eventos adversos graves. Los inhibidores del SGLT2 mostraron efectos cardioprotectores y nefroprotectores, con menor incidencia de lesión renal aguda, reducción de marcadores inflamatorios y mejores resultados tras cirugía de revascularización coronaria. En contraste, la evidencia sobre inhibidores del DPP-4 fue inconsistente, con beneficios poco concluyentes e incluso un posible riesgo de disfunción orgánica. En conclusión, agonistas del GLP1 e inhibidores del SGLT2 se perfilan como opciones seguras y prometedoras en cirugía cardíaca, mientras que el uso rutinario de inhibidores del DPP4 no está recomendado por la evidencia limitada y controvertida.


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