Current Diabetes Reports

, Volume 10, Issue 1, pp 24–31

Does Choice of Antidiabetes Therapy Influence Macrovascular Outcomes?



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.


Cardiovascular disease Antidiabetic medications Type 2 diabetes mellitus 

Clinical Trial Acronyms


Action to Control Cardiovascular Risk in Diabetes


Bypass Angioplasty Revascularization Investigation 2 Diabetes


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


Prospective Pioglitazone Clinical Trial in Macrovascular Events


Rosiglitazone Evaluation for Cardiac Outcomes and Regulation of Glycaemia in Diabetics

4 T

Treat To Target in Type 2 Diabetes


University Group Diabetes Program


United Kingdom Prospective Diabetes Study


Veteran Affairs Diabetes Trial

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineBridgeport HospitalBridgeportUSA

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