Cardiovascular disease prevention in patients with type 2 diabetes: The role of oral anti-diabetic agents.

Multiple risk factor intervention is essential in order to prevent cardiovascular (CV) disease in patients with diabetes. Therefore, to reduce atherothrombotic events, an ideal oral anti-diabetic agent should be able to modulate most, and preferably all, cardiovascular risk factors associated with diabetes. Of the currently available agents, the insulin sensitisers (metformin, thiazolidinediones) seem to have most promise in cardiovascular protection. Metformin has a positive effect on several CV risk factors; outcome studies have shown that this agent reduces cardiac events in overweight subjects with diabetes. In a similar manner, thiazolidinediones (rosiglitazone, pioglitazone) have a wide spectrum of activity, favourably modulating most risk factors, with evidence to suggest a reduction in CV events with this class of drugs. Agents in the sulphonylurea group have beneficial, though inconsistent, effects on some risk factors but outcome studies have failed to show a cardioprotective role for these agents. New classes of drugs to manage type 2 diabetes are currently at various stages of development and their role in prevention of cardiovascular disease awaits evaluation. At present, first-line management of insulin-resistant type 2 diabetes should utilise metformin, with the addition of thiazolidinediones and sulphonylureas to achieve optimal glycaemic control.