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Cardiovascular safety of non-insulin pharmacotherapy for type 2 diabetes

James Xu1,2, Rohan Rajaratnam3,4,5,6

  • 1Cardiology Department, Level 1 CSB, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia.

Cardiovascular Diabetology
|February 3, 2017
PubMed

Insights

Type 2 diabetes increases cardiovascular risk. While some anti-diabetic drugs show cardiovascular benefits, focusing on managing risk factors is key, not just glycemic control.

Area of Science:

  • Endocrinology and Metabolism
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Patients with type 2 diabetes mellitus (T2DM) face a doubled risk of cardiovascular mortality.
  • The glycemic efficacy of anti-diabetic medications does not always correlate with cardiovascular safety.
  • Recent trials have focused on evaluating the cardiovascular effects of various anti-diabetic drugs.

Purpose of the Study:

  • To review and examine the cardiovascular safety profiles of anti-diabetic agents based on major published clinical trials.
  • To provide an overview of the cardiovascular implications associated with different classes of oral anti-diabetic drugs.

Main Methods:

  • Systematic review of major published clinical trials assessing cardiovascular outcomes of anti-diabetic drugs.
  • Analysis of safety data and cardiovascular event rates associated with metformin, sulfonylureas, glitazones, incretin-based drugs, meglitinides, alpha-glucosidase inhibitors, and SGLT-2 inhibitors.

Main Results:

  • Metformin remains the first-line choice due to its established safety record.
  • Sulfonylureas are associated with adverse cardiovascular events; glitazones are contraindicated in heart failure.
  • Incretin-based drugs have shown reassuring cardiovascular safety profiles, while SGLT-2 inhibitors demonstrate potential cardiovascular benefits. Meglitinides and alpha-glucosidase inhibitors lack sufficient cardiovascular outcomes data.

Conclusions:

  • Many oral anti-diabetic agents possess clinically significant cardiovascular effects.
  • Optimal cardiovascular risk reduction in T2DM patients requires aggressive management of standard risk factors, prioritizing this over solely intensive glycemic control.
Keywords:
Anti-diabetic drugsCardiovascular outcome trialsType 2 diabetes

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