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Cardiovascular Outcome Trial Update in Diabetes: New Evidence, Remaining Questions

Rebecca Herbst1, Wilburn Bolton1, Afreen Shariff1

  • 1Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA.

Current Diabetes Reports
|July 21, 2017
PubMed
Abstract

Insights

Newer diabetes drugs show cardiovascular benefits. Sodium glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists reduce major adverse cardiovascular events (MACE) and improve kidney function in type 2 diabetes patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes (T2DM) management requires careful consideration of cardiovascular (CV) safety.
  • Recent trials have evaluated novel antihyperglycemic agents for their CV risk profiles.
  • Extensive data on drug classes like dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium glucose cotransporter-2 inhibitors are available.

Purpose of the Study:

  • To summarize recently completed trials assessing the cardiovascular safety of new agents for type 2 diabetes.
  • To review the CV outcomes associated with different classes of antihyperglycemic medications.

Main Methods:

  • Review of seven completed clinical trials on new T2DM agents.
  • Analysis of cardiovascular safety data, including major adverse CV events (MACE) and hospitalization for heart failure.
  • Assessment of renal function parameters in relation to CV outcome benefits.

Main Results:

  • Dipeptidyl peptidase-4 inhibitors did not alter MACE risk.
  • Glucagon-like peptide-1 receptor agonists (liraglutide, semaglutide) and empagliflozin (SGLT-2 inhibitor) significantly reduced MACE risk.
  • Empagliflozin also reduced hospitalization for heart failure and improved renal function.
  • Newer antihyperglycemic agents demonstrated CV benefits in high-risk T2DM patients.

Conclusions:

  • Several newer antihyperglycemic agents offer significant cardiovascular benefits for high-risk T2DM patients.
  • Agents like SGLT-2 inhibitors and GLP-1 receptor agonists are associated with reduced MACE and improved renal outcomes.
  • Further trials are necessary to evaluate additional drugs, lower-risk populations, and non-CV safety outcomes.
Keywords:
AntihyperglycemicCardiovascularDiabetesOutcomes

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