Cardiovascular outcome trials of the newer anti-diabetic medications

被引:23
作者
Acharya, Tushar [1 ]
Deedwania, Prakash [2 ]
机构
[1] Univ Arizona, Coll Med, Tucson, AZ USA
[2] Univ Calif San Francisco, San Francisco, CA 94143 USA
关键词
Diabetes mellitus; Cardiovascular disease; Medications; GLP-1; analogues; SGLT2; inhibitors; GLUCAGON-LIKE PEPTIDE-1; INTENSIVE GLUCOSE CONTROL; TYPE-2; DIABETES-MELLITUS; HEART-FAILURE; MYOCARDIAL-INFARCTION; GLYCEMIC CONTROL; LOWERING DRUGS; KIDNEY-DISEASE; INHIBITORS; FOLLOW-UP;
D O I
10.1016/j.pcad.2019.08.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Concerns of elevated cardiovascular disease (CVD) risk with some anti-diabetic medications warranted phase 4 clinical trials to demonstrate CVD safety of newly marketed anti-diabetic drugs. Although initially designed to evaluate safety, some of these CVD outcome trials (CVOTs) have in fact shown CVD benefits. New medication classes, like glucagon-like peptide 1 (GLP-1) analogues and sodium-glucose co-transporter 2 (SGLT2) inhibitors, have shown reductions in the risk of major adverse cardiovascular events (MACE) including, myocardial infarction, stroke, CV death, and heart failure (HF). Perhaps more importantly, SGLT2 inhibitors demonstrated reduction in the risk of HF hospitalizations, being the first class of anti-diabetic drugs to do so. Conversely, dipeptidyl peptidase 4 (DPP-4) inhibitors did not significantly affect atherosclerotic CVD end-points and some actually increased the risk of HF hospitalizations. Further, the adverse/beneficial CVD effects of these medications may not be class specific. This review focuses on the main results of these CVOTs while highlighting the heterogeneity of CVD end-points within each class and discusses important mechanistic insights and adverse effect profiles. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:342 / 348
页数:7
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