SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

Cardiovascular role of novel antidiabetics in randomized controlled trials and newer recommendations

█ Review

DOI: 10.26430/CHUNGARICA.2017.47.5.381

Bajnok László
Pécsi Tudományegyetem, I. sz. Belgyógyászati Klinika, Endokrinológiai és Anyagcsere Tanszék, Pécs


For 10 years after the promising secondary prophylactic effect of a thiazolidinedione, pioglitazone, studies testing (i) strict glycemic control (ACCORD, ADVANCE, VADT), (ii) early glycemic control (NAVIGATOR, ORIGIN), (iii) agents acting on the incretin axis ( SAVOR-TIMI 53, EXAMINE, TECOS, ELIXA) or (iv) another thiazolidinedione, rosiglitazone (RECORD) became frustrating. However, EMPA-REG OUTCOME with empagliflozin, a member of the SGLT2 inhibitor group, has been a real breakthrough in respect of marked reduction (35-44%) of cardiovascular mortality, hospitalization for cardiac failure and hard nephropathic endpoints. Subsequently, the following antidiabetic drugs have been shown to have significant cardiovascular benefit: (i) two GLP-1R agonists, the liraglutide and semaglutide (LEADER and SUSTAIN-6), as well as (ii) pioglitazone (IRIS), this time clearly, and (iii) another SGLT2 inhibitor, canagliflozin (CANVAS). Where the different guidelines for type 2 diabetes are consistent are the usage of metformin as the first line drug (despite the lack of modern evidence) and the preference of SGLT2 inhibitors, even in the early stages.


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