Southside Endocrinology, University of Alabama at Birmingham, Birmingham, AL.
Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
Rev Cardiovasc Med. 2013;14(2-4):e107-22. doi: 10.3909/ricm0671.
This review discusses the current data on various antidiabetic medications and their effects on major adverse cardiovascular events (MACE). Diabetes mellitus is a potent independent risk factor for MACE, and this risk increases in proportion to the elevation of hemoglobin A1c. Available data suggest that tight glycemic control in patients with diabetes reduces microvascular complications, but has limited effect or may even increase the risk of MACE and other macrovascular complications. For individuals with type 2 diabetes mellitus (T2DM) drugs that reduce postprandial glucose (α-glucosidase inhibitors, incretin mimetics, quick-acting bromocriptine, dipeptidyl peptidase-4 inhibitors, and colesevelam) are associated with a decrease in MACE. Drugs that directly reduce insulin resistance (pioglitazone and metformin) are also associated with lesser but still significant decreases in MACE. Insulin, rosiglitazone (but not pioglitazone), and sulfonylureas (especially with glyburide and particularly the glyburide + metformin combination) are associated with increases in MACE. In summary, drugs that reduce postprandial glucose and improve insulin resistance without predisposing patients to hypoglycemia appear to both control hyperglycemia and improve cardiovascular prognosis. However, many of the traditional agents used for treating T2DM, such as insulin and sulfonylureas, do not improve cardiovascular prognosis despite improving hyperglycemia.
这篇综述讨论了各种抗糖尿病药物及其对主要不良心血管事件（MACE）的影响的现有数据。糖尿病是 MACE 的一个强有力的独立危险因素，这种风险随着糖化血红蛋白的升高而增加。现有数据表明，糖尿病患者的严格血糖控制可减少微血管并发症，但对 MACE 和其他大血管并发症的风险影响有限，甚至可能增加。对于 2 型糖尿病（T2DM）患者，降低餐后血糖的药物（α-葡萄糖苷酶抑制剂、肠促胰岛素类似物、速效溴隐亭、二肽基肽酶-4 抑制剂和考来烯胺）与 MACE 降低相关。直接降低胰岛素抵抗的药物（吡格列酮和二甲双胍）也与 MACE 降低相关，但程度较轻。胰岛素、罗格列酮（而非吡格列酮）和磺酰脲类药物（尤其是格列本脲和格列本脲+二甲双胍联合用药）与 MACE 增加相关。总之，降低餐后血糖和改善胰岛素抵抗而不使患者易发生低血糖的药物似乎既能控制高血糖又能改善心血管预后。然而，许多用于治疗 T2DM 的传统药物，如胰岛素和磺酰脲类药物，尽管能改善高血糖，但并不能改善心血管预后。
