Cardiovascular effects of anti-diabetes drugs.
BACKGROUND
Cardiovascular disease remains the major contributor to morbidity and mortality in diabetes. From the need to reduce cardiovascular risk in diabetes and to ensure that such risk is not exacerbated by drug treatments, governmental regulators and drug manufacturers have focused on clinical trials evaluating cardiovascular outcomes.


METHODS
Findings from mechanistic and clinical trials of biguanides, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors will be reviewed. These drug classes will be compared within the context of available cardiovascular outcomes data. Clinical implications of new study regulations will be examined.


CONCLUSIONS
Recent cardiovascular studies provide a more comprehensive evaluation of specific anti-diabetes therapy in individuals with high cardiovascular risk. Long-term effects of anti-hyperglycemic agents in patients with lower cardiovascular risk are still speculative. Historical data supports continued use of metformin as a first-line agent. DPP-4 inhibitors and GLP-1 receptor agonists appear to have neutral effects on cardiovascular outcomes. The significantly decreased cardiovascular risk associated with empagliflozin SGLT-2 inhibitor therapy is impressive and may change how practitioners prescribe add-on therapy to metformin.
a Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA.
Lisa M
LM
Younk
b Division of Endocrinology, Diabetes and Nutrition , University of Maryland School of Medicine , Baltimore , MD , USA.
Elizabeth M
EM
Lamos
a Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA.
Stephen N
SN
Davis
D000818:Animals; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology
D007004:Hypoglycemic Agents
Cardiovascular risk; biguanides; dipeptidyl peptidase-4 inhibitors; glucagon-like peptide-1 agonists; sodium-glucose co-transporter 2 inhibitors; sulfonylureas; thiazolidinediones