Antidiabetic treatment in prevention of atherosclerosis: first half-century
Authors:
Ivan Tkáč
Authors‘ workplace:
Excelentný tím pre výskum aterosklerózy (EXTASY), IV. interná klinika UPJŠ LF a UN LP Košice
Published in:
Forum Diab 2021; 10(Supplementum 1): 9-15
Category:
Overview
The studies looking at the effect of antidiabetic drugs on cardiovascular disease in type 2 diabetes (T2D) in 1960–2010 have provided some valuable insights. The UGDP study indicated a possible risk of treatment by the sulphonylurea derivative tolbutamide and by a biguanide phenformin. In the UKPDS study, metformin was the only antidiabetic agent to have prevented cardiovascular morbidity and mortality in patients with T2D. However, neither the risk, nor the benefit of newer sulphonylureas or insulin has been demonstrated in the UPKDS study. Among PPAR-γ agonists, pioglitazone had a neutral effect on cardiovascular morbidity and mortality in the PROactive study. A meta-analysis pointed to a possible increased cardiovascular risk associated with rosiglitazone use, but it was not confirmed in the RECORD study. However, glitazones significantly increased the risk of hospitalizations for heart failure. Long-term achievement of HbA1c < 7 % with intensive T2D therapy tested in the ACCORD, ADVANCE and VADT studies has also not been shown to be beneficial, mainly due to an increased risk of hypoglycaemia in patients with pre-existing cardiovascular disease.
Keywords:
antidiabetic treatment – insulins – oral antidiabetic drugs – prevention of cardiovascular endpoints
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