Cardiovascular and Renal Outcomes of Newer Anti-Diabetic Medications in High-Risk Patients

Overview

Journal Curr Cardiol Rep

Publisher Current Science

Specialty Cardiology & Vascular Diseases

Date 2018 Jun 22

PMID 29926285

Citations 3

Authors

Lima Lawrence

Venu Menon

Sangeeta Kashyap

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: We review the cardiovascular and renal outcomes and safety of newer anti-diabetic medications in high-risk patients. We examine the outcomes of the IRIS, EMPA-REG OUTCOME, CANVAS, LEADER, SAVOR-TIMI 53, and EXAMINE trials demonstrating the cardiovascular and renal benefits of thiazolidinediones, SGLT2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors.

Recent Findings: Diabetes mellitus is a leading risk factor for cardiovascular disease with rising prevalence and disease burden. The microvascular and macrovascular complications of diabetes are well-recognized and include increased risk of cardiovascular disease, myocardial infarction, and stroke. Newer diabetes medications have demonstrated significant cerebrovascular, cardiovascular, renal, and mortality benefits in high risk patients with diabetes. In addition to their glucose-lowering effects, the thiazolidinedione pioglitazone, SGLT2 inhibitors, GLP-1 agonist, and DPP-4 inhibitors have demonstrated significant cerebrovascular, cardiovascular, renal, and mortality effects. The outcomes and safety data of newer diabetes medications from recent trials demonstrate cardiovascular and mortality effects with significant implications for clinical practice.

Citing Articles

Diabetes Mellitus Is a Chronic Disease that Can Benefit from Therapy with Induced Pluripotent Stem Cells.

Arroyave F, Montano D, Lizcano F Int J Mol Sci. 2020; 21(22).

PMID: 33217903 PMC: 7698772. DOI: 10.3390/ijms21228685.

Intensive Glycemic Control Improves Long-term Renal Outcomes in Type 2 Diabetes in the Veterans Affairs Diabetes Trial (VADT).

Agrawal L, Azad N, Bahn G, Reaven P, Hayward R, Reda D Diabetes Care. 2019; 42(11):e181-e182.

PMID: 31548245 PMC: 6804611. DOI: 10.2337/dc19-0891.

Pharmacologic adjunctive to insulin therapies in type 1 diabetes: The journey has just begun.

Karras S, Koufakis T, Zebekakis P, Kotsa K World J Diabetes. 2019; 10(4):234-240.

PMID: 31040899 PMC: 6475707. DOI: 10.4239/wjd.v10.i4.234.

References

Mann J, Orsted D, Brown-Frandsen K, Marso S, Poulter N, Rasmussen S . Liraglutide and Renal Outcomes in Type 2 Diabetes. N Engl J Med. 2017; 377(9):839-848. DOI: 10.1056/NEJMoa1616011. View

Scirica B, Bhatt D, Braunwald E, Steg P, Davidson J, Hirshberg B . Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013; 369(14):1317-26. DOI: 10.1056/NEJMoa1307684. View

Marso S, Daniels G, Brown-Frandsen K, Kristensen P, Mann J, Nauck M . Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016; 375(4):311-22. PMC: 4985288. DOI: 10.1056/NEJMoa1603827. View

Li L, Li S, Deng K, Liu J, Vandvik P, Zhao P . Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies. BMJ. 2016; 352:i610. PMC: 4772781. DOI: 10.1136/bmj.i610. View

Mearns E, Saulsberry W, White C, Kohn C, Lemieux S, Sihabout A . Efficacy and safety of antihyperglycaemic drug regimens added to metformin and sulphonylurea therapy in Type 2 diabetes: a network meta-analysis. Diabet Med. 2015; 32(12):1530-40. DOI: 10.1111/dme.12837. View

Kernan W, Viscoli C, Furie K, Young L, Inzucchi S, Gorman M . Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. N Engl J Med. 2016; 374(14):1321-31. PMC: 4887756. DOI: 10.1056/NEJMoa1506930. View

Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth A, Bansal N . Association of Cardiometabolic Multimorbidity With Mortality. JAMA. 2015; 314(1):52-60. PMC: 4664176. DOI: 10.1001/jama.2015.7008. View

Ussher J, Drucker D . Cardiovascular actions of incretin-based therapies. Circ Res. 2014; 114(11):1788-803. DOI: 10.1161/CIRCRESAHA.114.301958. View

Syed S, Gosavi S, Shami W, Bustamante M, Farah Z, Teleb M . A Review of Sodium Glucose Co-transporter 2 Inhibitors Canagliflozin, Dapagliflozin and Empagliflozin. Cardiovasc Hematol Agents Med Chem. 2015; 13(2):105-12. DOI: 10.2174/1871525714666151106121215. View

10.

Lin B, Koibuchi N, Hasegawa Y, Sueta D, Toyama K, Uekawa K . Glycemic control with empagliflozin, a novel selective SGLT2 inhibitor, ameliorates cardiovascular injury and cognitive dysfunction in obese and type 2 diabetic mice. Cardiovasc Diabetol. 2014; 13:148. PMC: 4219031. DOI: 10.1186/s12933-014-0148-1. View

11.

Chiarelli F, Di Marzio D . Peroxisome proliferator-activated receptor-gamma agonists and diabetes: current evidence and future perspectives. Vasc Health Risk Manag. 2008; 4(2):297-304. PMC: 2496982. DOI: 10.2147/vhrm.s993. View

12.

Kalra S . Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors: A Review of Their Basic and Clinical Pharmacology. Diabetes Ther. 2014; 5(2):355-66. PMC: 4269649. DOI: 10.1007/s13300-014-0089-4. View

13.

Knudsen L, Madsen L, Andersen S, Almholt K, DE Boer A, Drucker D . Glucagon-like Peptide-1 receptor agonists activate rodent thyroid C-cells causing calcitonin release and C-cell proliferation. Endocrinology. 2010; 151(4):1473-86. DOI: 10.1210/en.2009-1272. View

14.

Saad M, Mahmoud A, Elgendy I, Abuzaid A, Barakat A, Elgendy A . Cardiovascular outcomes with sodium-glucose cotransporter-2 inhibitors in patients with type II diabetes mellitus: A meta-analysis of placebo-controlled randomized trials. Int J Cardiol. 2016; 228:352-358. DOI: 10.1016/j.ijcard.2016.11.181. View

15.

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

16.

Gerstein H, Miller M, Byington R, Goff Jr D, Thomas Bigger J, Buse J . Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358(24):2545-59. PMC: 4551392. DOI: 10.1056/NEJMoa0802743. View

17.

Cefalu W, Riddle M . SGLT2 inhibitors: the latest "new kids on the block"!. Diabetes Care. 2015; 38(3):352-4. PMC: 5131877. DOI: 10.2337/dc14-3048. View

18.

Filion K, Azoulay L, Platt R, Dahl M, Dormuth C, Clemens K . A Multicenter Observational Study of Incretin-based Drugs and Heart Failure. N Engl J Med. 2016; 374(12):1145-54. DOI: 10.1056/NEJMoa1506115. View

19.

White W, Cannon C, Heller S, Nissen S, Bergenstal R, Bakris G . Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013; 369(14):1327-35. DOI: 10.1056/NEJMoa1305889. View

20.

Fu A, Johnston S, Ghannam A, Tsai K, Cappell K, Fowler R . Association Between Hospitalization for Heart Failure and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes: An Observational Study. Diabetes Care. 2016; 39(5):726-34. DOI: 10.2337/dc15-0764. View