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Diabetes Care. 2017 Jul;40(7):813-820. doi: 10.2337/dc16-2736.

Cardiovascular Disease and Type 2 Diabetes: Has the Dawn of a New Era Arrived?

Author information

1
Division of Diabetes, University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System, San Antonio, TX albarado@uthscsa.edu.
2
Diabetes Clinical Research Center, Academic Health System, Hamad General Hospital, Doha, Qatar.
3
Division of Diabetes, University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System, San Antonio, TX.
4
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
5
Division of Cardiology, University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System, San Antonio, TX.
6
Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, U.K.

Abstract

Hyperglycemia is the major risk factor for microvascular complications in patients with type 2 diabetes (T2D). However, cardiovascular disease (CVD) is the principal cause of death, and lowering HbA1c has only a modest effect on reducing CVD risk and mortality. The recently published LEADER and SUSTAIN-6 trials demonstrate that, in T2D patients with high CVD risk, the glucagon-like peptide 1 receptor agonists liraglutide and semaglutide reduce the primary major adverse cardiac events (MACE) end point (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke) by 13% and 24%, respectively. The EMPA-REG OUTCOME, IRIS (subjects without diabetes), and PROactive (second principal end point) studies also demonstrated a significant reduction in cardiovascular events in T2D patients treated with empagliflozin and pioglitazone. However, the benefit of these four antidiabetes agents (liraglutide, semaglutide, empagliflozin, and pioglitazone) on the three individual MACE end points differed, suggesting that different underlying mechanisms were responsible for the reduction in cardiovascular events. Since liraglutide, semaglutide, pioglitazone, and empagliflozin similarly lower the plasma glucose concentration but appear to reduce CVD risk by different mechanisms, there emerges the intriguing possibility that, if used in combination, the effects of these antidiabetes agents may be additive or even multiplicative with regard to cardiovascular benefit.

PMID:
28637886
PMCID:
PMC5481984
DOI:
10.2337/dc16-2736
[Indexed for MEDLINE]
Free PMC Article

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