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Novel Anti-glycemic Drugs and Reduction of Cardiovascular Risk in Diabetes: Expectations Realized, Promises Unmet

  • Clinical Trials and Their Interpretations (J. Kizer, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose is to review evidence on cardiovascular risks and benefits of new treatments for type 2 diabetes mellitus.

Recent Findings

In response to guidance issued by the Food and Drug Administration, thousands of patients have been enrolled in large randomized trials evaluating the cardiovascular effects of the three newest diabetes drug classes: glucagon-like peptide-1 (GLP-1) receptor agonists, sodium glucose cotransporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors. Two studies of GLP-1 receptor agonists—one of liraglutide and one of semaglutide—have shown cardiovascular benefit relative to placebo, and one study of the SGLT-2 inhibitor empagliflozin has shown benefit. The other published cardiovascular outcome studies of the newest drug classes have generally supported safety, apart from an as-yet unresolved safety concern about increased rates of heart failure with DPP-4 inhibitors. Recent research suggests the thiazolidinedione pioglitazone may have beneficial effects on some cardiovascular outcomes as well, but these are counterbalanced by a known increase of the risk of heart failure with this drug. In general, more prospective randomized trial data is now available regarding the cardiovascular effects of the newer diabetes drugs than on the older drug classes.

Summary

New evidence suggests that the newest diabetes drugs are safe from a cardiovascular perspective. Evidence on benefit from at least some members of the GLP-1 receptor agonist and SGLT-2 inhibitor classes is encouraging but not yet decisive.

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Authors and Affiliations

  1. Weill Cornell Medical College, 425 E 61st Street, Suite 301, New York, NY, 10065, USA

    James H. Flory & Jenny K. Ukena

  2. Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA

    James S. Floyd

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    James S. Floyd

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  1. James H. Flory
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James H. Flory, Jenny K. Ukena, and James S. Floyd declare that they have no conflict of interest.

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This article is part of the Topical Collection on Clinical Trials and Their Interpretations

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Flory, J.H., Ukena, J.K. & Floyd, J.S. Novel Anti-glycemic Drugs and Reduction of Cardiovascular Risk in Diabetes: Expectations Realized, Promises Unmet. Curr Atheroscler Rep 18, 79 (2016). https://doi.org/10.1007/s11883-016-0633-y

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