Cardiovascular disease and type 2 diabetes mellitus: regulating glucose and regulating drugs.
Type 2 diabetes mellitus is a major and increasingly prevalent independent risk factor for cardiovascular morbidity and mortality worldwide. Glycemic control is a target of therapy and a principal marker of therapeutic success in diabetes, but whether lowering glucose is accompanied by a commensurate reduction in cardiovascular risk is a matter of ongoing controversy. It has become increasingly apparent from recent large-scale clinical outcome trials that glucose lowering is a poor predictor of cardiovascular outcome, and several instances of unexpectedly increased cardiovascular risk with antihyperglycemic drugs have sounded the alarm with regulatory agencies. This article reviews the critical facts that have led to a recent shift in the regulation of glucose-lowering drugs and makes the case for why new and existing antidiabetic medications should be assessed in clinical trials of cardiovascular outcome.
Gore
M Odette
MO
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75235-9047, USA.
McGuire
Darren K
DK
D000924:Anticholesteremic Agents / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D011804:Quinolines / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects
D000924:Anticholesteremic Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D011804:Quinolines; D000077154:Rosiglitazone; D045162:Thiazolidinediones; C517652:hemoglobin A1c protein, human; C483909:torcetrapib