Cardiovascular safety of anti-diabetic drugs

Abstract

Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, underscoring the importance of choosing anti-diabetic drugs that do not increase cardiovascular risk but might reduce the risk of cardiovascular events. Most type 2 diabetic patients die from cardiovascular causes despite the beneficial effects of blood pressure (BP) and lipid-lowering medications. The prevalence of patients with cardiovascular disease and diabetes mellitus is growing exponentially. Approximately 40% of patients hospitalized with heart failure and reduced ejection fraction have diabetes mellitus. The recent trials conducted in patients with heart failure who had diabetes showed a different response to standard medication, with these patients being more prone to develop side effects than patients with the same degree of heart failure but without diabetes mellitus. Therefore, careful selection of drug therapy paying particular attention to cardiovascular safety is important in optimizing diabetic therapy. This review discusses the efficacy and safety of the most commonly prescribed anti-diabetic drugs in the context of cardiovascular impact.

Comparative effectiveness of oral antidiabetic drugs in preventing cardiovascular mortality and morbidity: A network meta-analysis

“…Sulfonylureas act on pancreatic beta-cells, independently of serum glucose levels, to enhance insulin secretion, potentially causing adverse hypoglycemic events. This can prolong the QT interval and is associated with cardiac ischemia [19], increasing the risk of arrhythmias, acute MI, and sudden cardiac death [8]. A previous meta-analysis also reported a lower risk of hypoglycemia with SGLT2 inhibitors than with sulfonylureas [20].…”

“…However, most trials failed to demonstrate a reduction in the risk of cardiovascular mortality or morbidity, although these drugs were deemed safe [2,8]. The most recently reported randomized controlled trial (RCT), the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) trial, showed that SGLT2 inhibitor use decreases the risk of cardiovascular events, compared with placebo [9].…”

Cardiovascular benefits of the newer medications for treating type 2 diabetes mellitus

“…SGLT-2 inhibitors improve both glycemic and nonglycemic risk factors in T2DM patients. They induce urinary glucose losses around 40-80 g/day, resulting in decent glycemic control (HbA1c reduction around 0.7%) (42). This corresponds to around 200-300 kilocalories daily which can result in a 2-3 kg body weight loss over 24-52 weeks (40).…”

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

“…Mortality following hospitalization for HF is high, reaching 19.8% at 2.25 years in the control arm of a recent randomized HF trial [5]. Early treatment of hypertension has been shown to be effective in preventing hospitalization for HF in high-risk subjects [6]; however, intensive hypoglycemic therapy and a number of hypoglycemic agents may increase the risk of HF in diabetics, emphasizing the need for early identification of those at risk for HF and appropriate selection of hypoglycemic drugs [7,8]. Predictive models for death or HF based on clinical risk factors in heterogeneous populations have had only moderate success [9].…”