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Does Choice of Antidiabetes Therapy Influence Macrovascular Outcomes?

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Abstract

Despite a clear epidemiologic relationship between hemoglobin A1c levels and the risk of cardiovascular (CV) disease in patients with type 2 diabetes mellitus (T2DM), prospective studies examining the benefit of intensive glucose lowering in reducing CV events have yielded conflicting results. Controversy over the choice of antidiabetic therapy for lowering macrovascular events has existed for nearly four decades, beginning with the potential risk of increased CV mortality with sulfonylurea use. Although sulfonylureas were subsequently felt to be safe, a more recent controversy was raised as to whether rosiglitazone use was associated with an increased risk of CV events. Additionally, early positive results for metformin in reducing macrovascular events have not been clearly substantiated. Because a typical patient with T2DM may live 20 to 40 years with the disease, long-term prevention of CV events is very important. An evidenced-based review of choice of antidiabetic therapy to reduce CV events in T2DM is discussed below.

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Abbreviations

ACCORD:

Action to Control Cardiovascular Risk in Diabetes

BARI 2D:

Bypass Angioplasty Revascularization Investigation 2 Diabetes

HEART2D:

Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus

PROactive:

Prospective Pioglitazone Clinical Trial in Macrovascular Events

RECORD:

Rosiglitazone Evaluation for Cardiac Outcomes and Regulation of Glycaemia in Diabetics

4 T:

Treat To Target in Type 2 Diabetes

UGDP:

University Group Diabetes Program

UKPDS:

United Kingdom Prospective Diabetes Study

VADT:

Veteran Affairs Diabetes Trial

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Disclosure

Dr. Stuart Zarich has received research grants, consulting, and honorarium from GlaxoSmithKline, Pfizer, Sanofi Aventis, and Novartis.

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  1. Division of Cardiovascular Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA

    Stuart W. Zarich

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Zarich, S.W. Does Choice of Antidiabetes Therapy Influence Macrovascular Outcomes?. Curr Diab Rep 10, 24–31 (2010). https://doi.org/10.1007/s11892-009-0083-9

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