title: What Are We Learning from the FDA-Mandated Cardiovascular Outcome Studies for New Pharmacological Antidiabetic Agents?
abstract: Cardiovascular disease (CVD) is common in patients with diabetes. For these patients, clinicians should seek diabetes treatment that is beneficial rather than harmful in relation to CVD. Until recently, there have been many treatments for hyperglycemia, whose impact on CVD has been controversial. The aims of this review are to evaluate the effectiveness of antihyperglycemic medications on risk factors for CVD and to examine the impact of these drugs on CVD in cardiovascular (CV) outcome trials. In this article, we summarize current knowledge about the impacts of these drugs on various risk factors as well as CV outcomes. We identify the recent emergence of trials with antihyperglycemic agents showing newly discovered CV benefits as well as past trials with antihyperglycemic agents not showing much benefit on CV events. Rather than focusing on treatment strategies, we review the effects of individual drug classes on CV outcomes. We also briefly review goal-driven glycemia reduction and its impact on CVD. We conclude that antihyperglycemic agents are associated with improvement in CV risk factors in patients with diabetes and insulin resistance; in fact, a few drugs reduced CV events in randomized CV outcome trials. Therefore, the use of these drugs is appropriate for reducing glucose and decreasing CV event risk in a select subpopulation.
authors.affiliation: Tulane University Health Sciences Center, 1430 Tulane Ave., SL-53, New Orleans, LA, 70112, USA. dlovre@tulane.edu.
authors.forename: Dragana
authors.initials: D
authors.lastname: Lovre
authors.affiliation: Tulane University Health Sciences Center, 1430 Tulane Ave., SL-53, New Orleans, LA, 70112, USA.
authors.forename: Wynn
authors.initials: W
authors.lastname: Htun
authors.affiliation: Tulane University Health Sciences Center, 1430 Tulane Ave., SL-53, New Orleans, LA, 70112, USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Carrion
authors.affiliation: Tulane University Health Sciences Center, 1430 Tulane Ave., SL-53, New Orleans, LA, 70112, USA.|Southeast Louisiana Veterans Health Care Systems, New Orleans, USA.
authors.forename: Vivian A
authors.initials: VA
authors.lastname: Fonseca
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D014481:United States; D014486:United States Food and Drug Administration; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
keywords: Antihyperglycemic agents; Cardiovascular outcome studies; Cardiovascular risk factors; Diabetes management; Diabetes mellitus; Risk factors for cardiovascular disease