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Cardiovascular disease and type 2 diabetes mellitus: regulating glucose and regulating drugs

M Odette Gore1, Darren K McGuire

  • 1Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75235-9047, USA.

Current Cardiology Reports
|July 1, 2009
PubMed

Insights

Type 2 diabetes increases cardiovascular risks. While glycemic control is key, lowering glucose doesn't always reduce cardiovascular events, prompting a re-evaluation of antidiabetic drug safety and efficacy.

Area of Science:

  • Endocrinology
  • Cardiology
  • Pharmacology

Background:

  • Type 2 diabetes mellitus is a significant global risk factor for cardiovascular disease (CVD) morbidity and mortality.
  • Glycemic control is a primary therapeutic goal in diabetes management, but its direct impact on cardiovascular risk reduction remains controversial.
  • Recent clinical trials indicate that glucose-lowering is an unreliable predictor of cardiovascular outcomes, with some drugs showing increased cardiovascular risk.

Purpose of the Study:

  • To review the evidence prompting regulatory shifts in glucose-lowering drug assessment.
  • To advocate for the mandatory evaluation of cardiovascular outcomes in clinical trials for all antidiabetic medications.

Main Methods:

  • Review of large-scale clinical outcome trials.
  • Analysis of regulatory agency alerts regarding antihyperglycemic drugs.
  • Synthesis of evidence on the relationship between glycemic control and cardiovascular risk.

Main Results:

  • Glucose-lowering efficacy does not consistently correlate with reduced cardiovascular risk.
  • Certain antihyperglycemic agents have demonstrated unexpected increases in cardiovascular risk.
  • Regulatory agencies have initiated changes in drug evaluation protocols.

Conclusions:

  • The link between glycemic control and cardiovascular risk reduction in Type 2 diabetes is complex and not fully understood.
  • New and existing antidiabetic drugs require rigorous assessment for cardiovascular safety and efficacy through dedicated outcome trials.
  • A paradigm shift in antidiabetic drug development and regulation is necessary to prioritize patient cardiovascular health.

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