Cardiovascular benefits and risk profiles of oral anti-diabetic agents: current evidence and ongoing trials

Type 2 diabetes increases the risk of developing cardiovascular (CV) morbidity and mortality. Strict glycemic control may produce CV benefit in newly diagnosed or short duration diabetes, but not in longstanding complicated diabetic patients, especially in those with high risk of hypoglycemia. In 2008, the US Food and Drug Administration (FDA) revised regulations for the approval of medications for type 2 diabetes by requiring adequate CV safety evidences. Recently, major concerns have arisen about current oral anti-diabetic agents (OADs). This review will be focused on CV benefits and risk profiles of currently available OADs based on evidences from landmark randomized controlled trials and meta-analyses. Metformin, sulfonylureas (SUs), and alpha-glucosidase inhibitors have limited and/or controversial data on CV safety evaluation. Peroxisome proliferator-activated receptor gamma agonists or thiazolidinediones EDITORIAL Cardiovascular Benefits and Risk Profiles of Oral Anti-Diabetic Agents: Current Evidence and Ongoing Trials Shih-Che Hua, Juey-Jen Hwang, Yi-Cheng Chang 386 Journal of Cardiol Ther 2015 October 2(5): 386-392 ISSN 2309-6861(print), ISSN 2312-122X(online) Online Submissions: http://www.ghrnet.org/index./jct/ doi:10.17554/j.issn.2309-6861.2015.02.87 © 2015 ACT. All rights reserved. Journal of Cardiology and Therapy (TZDs), dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodiumglucose co-transporter type 2 (SGLT2) inhibitors have been more extensively evaluated in well-designed CV outcome trials. A recently published randomized clinical trials demonstrated empagliflozin reduced CV risks and mortality in high CV risks type 2 diabetes patients. Ongoing trials will elucidate the CV safety for TZDs (pioglitazone), DPP-4 inhibitors, and SGLT2 inhibitors compared to SUs or placebo. © 2015 ACT. All rights reserved.