a Second Propedeutic Department of Internal Medicine , Aristotle University , Thessaloniki , Greece.
b Department of Internal Medicine , George Washington University , Washington , DC , USA.
Expert Opin Drug Saf. 2019 Mar;18(3):241-251. doi: 10.1080/14740338.2019.1586881. Epub 2019 Mar 8.
Diabetes mellitus is a major public health problem with significant macro- and microvascular complications. Achievement of glucose control is associated with a substantial reduction of microvascular events, while the effects of antidiabetic drugs in macro-vascular complications are less clear. This review summarizes and critically discusses the cardiovascular effects of non-insulin antidiabetic agents.
A selective literature search of Pubmed was performed regarding the efficacy and safety of non-insulin antidiabetic agents in randomized controlled clinical trials and relevant meta-analyses. Data are presented for all major classes of antidiabetic drugs: metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 analogues, and SGLT-2 inhibitors. Efficacy and safety were focused on the cardiovascular system.
Disparities in cardiovascular safety and efficacy between antidiabetic drugs exist. Metformin remains the first-choice drug with proven cardiovascular benefits. The cardiovascular profile of sulfonylureas is yet unclarified, while thiazolidinediones seem to be effective in secondary stroke prevention but heart failure concerns limit their use. The cardiovascular safety of DPP-4 inhibitors has been demonstrated, without however significant morbidity and mortality benefits. SGLT-2 inhibitors and GLP-1 analogues offer significant cardiovascular benefits and are recommended for patients with overt cardiovascular disease.
糖尿病是一个重大的公共卫生问题，存在显著的大血管和微血管并发症。实现血糖控制与微血管事件的大量减少相关，而抗糖尿病药物对大血管并发症的影响则不太明确。这篇综述总结并批判性地讨论了非胰岛素类抗糖尿病药物的心血管效应。
对 Pubmed 进行了选择性文献检索，以获取关于非胰岛素类抗糖尿病药物在随机对照临床试验和相关荟萃分析中的疗效和安全性的数据。为所有主要类别的抗糖尿病药物提供了数据：二甲双胍、磺酰脲类、噻唑烷二酮类、DPP-4 抑制剂、GLP-1 类似物和 SGLT-2 抑制剂。重点关注了心血管系统的疗效和安全性。
抗糖尿病药物在心血管安全性和疗效方面存在差异。二甲双胍仍然是具有心血管获益证据的首选药物。磺酰脲类的心血管特征尚不清楚，而噻唑烷二酮类似乎对二级卒中预防有效，但心力衰竭问题限制了其使用。DPP-4 抑制剂的心血管安全性已得到证实，但并未带来显著的发病率和死亡率获益。SGLT-2 抑制剂和 GLP-1 类似物具有显著的心血管获益，推荐用于有明显心血管疾病的患者。
