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Does choice of antidiabetes therapy influence macrovascular outcomes?

Stuart W Zarich1

  • 1Division of Cardiovascular Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA. pszari@bpthosp.org

Current Diabetes Reports
|April 29, 2010
PubMed

Insights

Controlling hemoglobin A1c in type 2 diabetes mellitus (T2DM) is linked to cardiovascular disease risk. This review examines antidiabetic therapies to reduce cardiovascular events in T2DM patients.

Area of Science:

  • Endocrinology
  • Cardiology
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (T2DM) is associated with a significant risk of cardiovascular (CV) disease.
  • The relationship between hemoglobin A1c levels and CV risk in T2DM is well-established epidemiologically.
  • Despite this, prospective studies on intensive glucose-lowering benefits for CV events show conflicting results.

Purpose of the Study:

  • To provide an evidence-based review of antidiabetic therapies for reducing CV events in T2DM.
  • To address the long-standing controversy regarding the choice of antidiabetic medications and their impact on macrovascular outcomes.
  • To inform clinical decisions for long-term CV event prevention in T2DM patients.

Main Methods:

  • Review of existing prospective studies and epidemiological data.
  • Analysis of historical and recent controversies surrounding specific antidiabetic drug classes (sulfonylureas, rosiglitazone, metformin).
  • Evidence-based assessment of therapeutic strategies for macrovascular risk reduction in T2DM.

Main Results:

  • Conflicting results exist regarding the efficacy of intensive glucose lowering in reducing CV events in T2DM.
  • Historical concerns about sulfonylureas and CV mortality have evolved, with current consensus suggesting safety.
  • Controversies persist regarding rosiglitazone's CV safety, and metformin's macrovascular benefits require clearer substantiation.

Conclusions:

  • Long-term prevention of CV events is crucial for T2DM patients, who may live decades with the disease.
  • The choice of antidiabetic therapy requires careful consideration of CV risk and evidence.
  • Further research and clear guidelines are needed to optimize antidiabetic treatment for cardiovascular risk reduction in T2DM.

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