Title:Novel Approaches to the Management of Diabetes Mellitus in Patients with
Coronary Artery Disease
Volume: 29
Issue: 23
Author(s): Evangelos Oikonomou*, Maria Xenou, George E. Zakynthinos, Paraskevas Tsaplaris, Stamatios Lampsas, Evanthia Bletsa, Ioannis Gialamas, Konstantinos Kalogeras, Athina Goliopoulou, Maria I. Gounaridi, Theodoros Pesiridis, Aikaterini Tsatsaragkou, Manolis Vavouranakis, Gerasimos Siasos and Dimitris Tousoulis
Affiliation:
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of
Athens, Athens, Greece
Keywords:
Diabetes mellitus, cardiovascular disease, antidiabetic drugs, pathophysiology, SGLT-2 inhibitors, GLP1RAs.
Abstract: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in individuals with diabetes
mellitus (DM). Although benefit has been attributed to the strict control of hyperglycemia with traditional
antidiabetic treatments, novel antidiabetic medications have demonstrated cardiovascular (CV) safety and benefits
by reducing major adverse cardiac events, improving heart failure (HF), and decreasing CVD-related mortality.
Emerging data underline the interrelation between diabetes, as a metabolic disorder, and inflammation,
endothelial dysfunction, and oxidative stress in the pathogenesis of microvascular and macrovascular complications.
Conventional glucose-lowering medications demonstrate controversial CV effects. Dipeptidyl peptidase-
4 inhibitors have not only failed to prove to be beneficial in patients with coronary artery disease, but also
their safety is questionable for the treatment of patients with CVD. However, metformin, as the first-line option
for type 2 DM (T2DM), shows CVD protective properties for DM-induced atherosclerotic and macrovascular
complications. Thiazolidinedione and sulfonylureas have questionable effects, as evidence from large studies
shows a reduction in the risk of CV events and deaths, but with an increased rate of hospitalization for HF.
Moreover, several studies have revealed that insulin monotherapy for T2DM treatment increases the risk of major
CV events and deaths from HF, when compared to metformin, although it may reduce the risk of myocardial
infarction. Finally, this review aimed to summarize the mechanisms of action of novel antidiabetic drugs
acting as glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors that show favorable
effects on blood pressure, lipid levels, and inflammation, leading to reduced CVD risk in T2DM patients.
