Cardiovascular Risk in Diabetes Mellitus: Complication of the Disease or of Antihyperglycemic Medications

Abstract

Cardiovascular disease is the principal complication and the leading cause of death for patients with diabetes (DM). The efficacy of anti-hyperglycemic treatments on cardiovascular disease risk remains uncertain. Cardiovascular risk factors are affected by anti-hyperglycemic medications, as are many intermediate markers of cardiovascular disease. Here we summarize the evidence assessing the cardiovascular effects of anti-hyperglycemic medications with regards to risk factors, intermediate markers of disease, and clinical outcomes.

Type 2 Diabetes: Progress Made but Still a Long Road to Travel to Reduce Disease Burden

“…However, some antidiabetic drugs also have adverse cardiovascular effects, a fact that underlies the need for these drugs to be assessed in cardiovascular outcomes trials during development. Alvarez et al . reviewed the entire field of the management of DM.…”

“…However, some antidiabetic drugs also have adverse cardiovascular effects, a fact that underlies the need for these drugs to be assessed in cardiovascular outcomes trials during development. Alvarez et al 14 reviewed the entire field of the management of DM. Antidiabetic drugs may have direct adverse effects on the cardiovascular system, or indirect effects through their metabolic actions, especially by modulating changes in serum lipids.…”

Effects of sodium–glucose cotransporter 2 inhibitors in addition to insulin therapy on cardiovascular risk factors in type 2 diabetes patients: A meta‐analysis of randomized controlled trials

“…One of the most common macrovascular complications of diabetes is coronary atherosclerotic heart disease. The rate of myocardial infarction and heart failure in diabetes patients is far higher than the rate in patients without diabetes. Therefore, when choosing therapies for diabetes patients, we must evaluate whether the treatment will lower the risk of cardiovascular disease associated with selected antidiabetic agents, and whether it can improve prognoses in diabetes‐associated cardiovascular disease.…”

Effects of Type 2 Diabetes Mellitus in Patients on Treatment With Glibenclamide and Metformin on Carvedilol Enantiomers Metabolism

“…Consequently, the use of carvedilol in patients with cardiovascular diseases and diabetes may have potentially beneficial effects. However, the administration of carvedilol has not been explored well in clinical practice, not only because of the reluctance to administer β‐adrenergic antagonists to diabetes patients but also because little is known about the influence of diabetes mellitus and oral hypoglycemics on carvedilol pharmacokinetics …”

“…However, the administration of carvedilol has not been explored well in clinical practice, 19 not only because of the reluctance to administer β-adrenergic antagonists to diabetes patients but also because little is known about the influence of diabetes mellitus and oral hypoglycemics on carvedilol pharmacokinetics. 3,20 Carvedilol is a chiral drug that is available as a racemic mixture of (R)-(+)-and (S)-(-)-carvedilol. (S)-(-)-carvedilol is a nonselective β-adrenergic antagonist and an α 1 -adrenergic antagonist, whereas (R)-(+)-carvedilol exerts only α 1 -adrenergic antagonist activity.…”