Treatment of diabetes mellitus has borne much fruit in the prevention of cardiovascular disease

Abstract

Cardiovascular (CV) disease is the most alarming complication of diabetes mellitus (DM), and a strategy aiming at cardiovascular event prevention in diabetes mellitus has long been debated. Large landmark clinical trials have shown cardiovascular benefits of intensive glycemic control as a ‘legacy effect’ in newly diagnosed type 2 diabetes mellitus. In contrast, we have learned that excessive intervention aimed at strong glycemic control could cause unexpected cardiovascular death in patients who are resistant to treatments against hyperglycemia. It has also been shown that the comprehensive multifactorial intervention for cardiovascular risk factors that was advocated in the current guideline provided substantial cardiovascular event reduction. The impact of classical antidiabetic agents launched before 1990s on cardiovascular events is controversial. Although there are many clinical or observational studies assessing the impact of those agents on cardiovascular events, the conclusions are inconsistent owing to variable patient backgrounds and concomitant antidiabetic agents among the studies. Moreover, most of them were not large‐scale, randomized, cardiovascular outcome trials. In contrast, GLP‐1RA (glucagon‐like peptide‐1 receptor agonist) and SGLT2 (sodium‐glucose cotransporter 2) inhibitors have demonstrated undeniable cardiovascular benefits in large‐scale, randomized, controlled trials. Whereas GLP‐1RAs decrease atherosclerotic disease, especially stroke, SGLT2 inhibitors mainly prevent heart failure. SGLT2 inhibitors are superior to GLP‐1RAs with respect to hard renal outcomes. Therefore, it can be said that drugs such as GLP‐1RAs and SGLT2 inhibitors that prevent cardiovascular events, in addition to their glucose‐lowering effect, are incredible novel tools that we have gained for use in diabetic treatment.

Interplay of cardiovascular health and diabetes: Insights into weight management and risk reduction

“…Another retrospective cohort study using Japanese hospital administrative data also indicated that SGLT2 inhibitors were more effective than DPP‐4 inhibitors in reducing hospitalization for heart failure and all‐cause mortality in patients with type 2 diabetes, particularly in those without a history of cardiovascular disease 18 . These results reaffirm the importance of SGLT2 inhibitors as a valuable medical intervention in line with recent diabetes treatment recommendations to reduce cardiovascular risk in Asia 19 , 20 .…”

Intensified Multifactorial Intervention in Patients with Type 2 Diabetes Mellitus

“…Two other trials are of major interest, in that they were conducted to elucidate the role of multifactorial intervention in patients with type 2 diabetes mellitus [ 13 , 14 ]: the Anglo-DanishDutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care (ADDITION)-Europe [ 15 ], and the Japan Diabetes Optimal Treatment study for 3 major risk factors of cardiovascular diseases (J-DOIT3) [ 16 ], both of which recruited more than 2,000 patients with less advanced microangiopathies.…”