Update on Cardiovascular Effects of Older and Newer Anti-diabetic Medications

Title:Update on Cardiovascular Effects of Older and Newer Anti-diabetic Medications

Volume: 25 Issue: 13

Author(s): Ioanna Eleftheriadou, Pinelopi Grigoropoulou, Evangelos Liberopoulos, Stavros Liatis, Alexandros Kokkinos and Nikolaos Tentolouris*

Affiliation:

• First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens,Greece

Keywords: Cardiovascular events, metformin, sulfonylureas, pioglitazone, insulin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporters-2 inhibitors.

Abstract: It is known that Cardiovascular (CV) disease is the leading cause of morbidity and mortality in individuals with type 2 diabetes. Over the last years, one of the most discussed topics is the CV safety of anti-diabetic medications. Regarding CV safety of older antidiabetic agents the data are less clear and conclusions about their CV safety are mostly based on randomized controlled trials designed to assess their glucose lowering efficacy. In this review, we summarize the current knowledge about the CV safety of older and newer antidiabetic medications.

According to the published literature metformin is the first line agent for the treatment of type 2 diabetes and seems to have cardio-protective effects. The choice of the second line agent when metformin monotherapy fails to achieve HbA1c targets is less clear. In the light of the findings of the EMPA-REG OUTCOME trial and the recently published LEADER and SUSTAIN 6 trials, empagliflozin, liraglutide and semaglutide seem reasonable options as second line agents for patients with CV disease. Sulfonylureas on the other hand, with the exception of gliclazide, should be avoided in those patients, although CV safety trials are still lacking. In individuals without CV disease any of the other classes of anti-diabetic medication can be selected on a patient-centered approach. Saxagliptin, alogliptin, sitagliptin and lixisenatide have been evaluated in CV safety trials and have neutral effects on CV outcomes, while pioglitazone may have some CV benefits. Saxagliptin and alogliptin, however, should be avoided in patients with heart failure, while pioglitazone is contraindicated in this population.

Cite this article as:

Eleftheriadou Ioanna , Grigoropoulou Pinelopi, Liberopoulos Evangelos, Liatis Stavros , Kokkinos Alexandros and Tentolouris Nikolaos*, Update on Cardiovascular Effects of Older and Newer Anti-diabetic Medications, Current Medicinal Chemistry 2018; 25 (13) . https://dx.doi.org/10.2174/0929867324666170530075533