Cardiovascular Effects of Hypoglycemic Agents in Diabetes Mellitus

BACKGROUND: Despite substantial improvements over the years, diabetes mellitus is still associated with cardiovascular disease, heart failure and excess mortality.

OBJECTIVE: The objective of this article is to examine existing data on how to reduce the excess cardiovascular morbidity and mortality in diabetes. Lifestyle changes, control of glycemia, blood pressure and lipid levels are described in brief. The main scope of this article is, however, the glucose-independent cardiovascular effect of antidiabetic pharmacological agents (mainly other than insulin).

METHODS: The article is a narrative review based on a systematic review of recently published reviews/meta-analyses within the subtopics, complemented with data from individual included and other trials when relevant.

RESULTS AND DISCUSSION: Older date data suggesting a cardioprotective role of Metformin (a cheap and safe drug) seem not to be challenged in a convincing manner. The cardiovascular effects of thiazolidinediones, sulphonylureas and glinides are debatable. More recent large scale cardiovascular outcome trials suggest a neutral profile of dipeptidyl peptidase 4 inhibitors, however, compelling evidence of cardioprotective effects of glucagon-like 1 receptor antagonists and sodium-glucose transporter 2 inhibitors is present.

CONCLUSION: Both play a role in secondary prevention of atherosclerotic cardiovascular disease. Additionally, sodiumglucose transporter 2 inhibitors play a role in both primary and secondary prevention of heart failure, yet at a price of the rare, but potentially dangerous, euglyceamic diabetic ketoacidosis.