title: [Cardiovascular outcome trials in patients with diabetes].
abstract: Although cardiovascular risk in patients with diabetes progressively increases with higher levels of blood glucose and glycated hemoglobin, none of currently available outcome trials has provided a clear demonstration that the improvement of glycemic control prevents cardiovascular disease. Meta-analyses of trials show that, for a reduction of glycated hemoglobin of 1%, the incidence of major cardiovascular events is reduced by about 10%; conversely, effects on cardiovascular mortality are heterogeneous. Available data suggest that early treatment in patients with lower levels of comorbidity can be more effective than in individuals with established diabetic complications. In addition, hypoglycemia induced by intensified treatment may have a negative impact on cardiovascular mortality. Furthermore, the possibility that individual drugs, or classes of drugs, for diabetes have either beneficial or detrimental effects on cardiovascular risk independent of their glucose-lowering action should be carefully considered. In this respect, many of the newer agents seem to have favorable actions. However, currently ongoing cardiovascular outcome trials, which were designed following regulatory requirements for safety purposes, are not very fit for the demonstration of cardiovascular benefits associated with novel diabetes therapies.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents