The effect of antidiabetic medications on the cardiovascular system: a critical appraisal of current data

Abstract

Both type 1 and type 2 diabetes are associated with increased risk for cardiovascular disease (CVD) events. This risk seems to be reduced by achievement of euglycemia. However, after the withdrawal of rosiglitazone from the market, the question arose as to whether this risk concerns simply a matter of euglycemia or the distinct role played by each antidiabetic drug with respect to its effect on CVD risk. To address this issue, many studies have been published during the last decade involving old and new antidiabetic agents, which however yielded contradictory results. Briefly, metformin is still considered safe and confers a beneficial effect on CVD risk. Conflicting data exist as concerns sulfonylureas, although the second and third generation representatives are regarded as relatively safe. Pioglitazone use seems to be associated with a reduction in CVD risk, whereas the dipeptidyl-dipeptidase-4 inhibitors (DPP-4i), lixisenatide and exenatide-LAR [from the category of glucagon-like-peptide-1 receptor (GLP-1R) agonists], confer a neutral effect. Two other GLP-1R agonists, liraglutide and semaglutide, as well as the sodium-glucose transporter-2 (SGLT2)-inhibitors, empagliflozin and cangliflozin, have shown an additional effect on CVD risk reduction, although their safety is in doubt. Insulin analogues and newer long-acting compounds are also safe for the cadiovascular system. The aim of this narrative review is to present and critically analyse the current data for each antidiabetic drug category with regard to their effect on CVD risk.

Tolbutamide Eye Drops Increase Aqueous Humor Outflow and Lower Intraocular Pressure: A Proof of Concept for Glaucoma Treatment

“…In the pancreas, tolbutamide inhibits the opening of KATP channels resulting in membrane depolarization, voltage activated calcium channels opening, Ca +2 influx into beta cells and insulin secretion [31]. KATP channels in their various isoforms are found in most cells and tissues, where the various isoforms confer upon the channels specific properties that regulate the tissue metabolic activities [47][48][49][50][51][52][53][54][55].…”

Sulfonilureas. Estado actual de su empleo en América Latina. Documento de posición de la Asociación Latinoamericana de Diabetes

“…En estos estudios, estas SU no se asociaron con un riesgo aumentado de ninguno de los principales resultados evaluados: muerte por todas las causas (OR: 1.12; IC 95%: 0.96-1.30), muerte cardiovascular (OR: 1.12; IC 95%: 0.87-1.42), infarto de miocardio (OR: 0.92; IC 95%: 0.76-1.12) o accidente cerebrovascular (OR: 1.16; IC 95%: 0.81-1.66) 10 . Estos resultados fueron similares cuando los brazos de SU se compararon con las intervenciones placebo/ dieta o se compararon con otras intervenciones activas 24 . Por último, las SU analizadas individualmente y tal vez la dosis de exposición también pueden estar asociadas a un riesgo cardiovascular diferenciado.…”

The Effect of Shrimp Shell (Litopenaeus vannamei) Extract on Testicular Parameters of Streptozotocin-induced Diabetic Rats

“…Studies regarding the effectiveness of existing antidiabetic drugs on the male reproductive system have been carried out in animal models of DM (Adaramoye and Lawal, 2014;Alves et al, 2014;Ayuob et al, 2015;Zaidi et al, 2017;He et al, 2021). Although the use of antidiabetic drugs is relatively safe and they have been widely prescribed in patients with DM, some side effects, such as hypoglycemia, hyperlactatemia, or metabolic acidosis, may still result from long-term use of currently available antidiabetic drugs (Anagnostis et al, 2018;Wang and Hoyte, 2019).…”