Antidiabetics and Heart Failure - Large Trials but Little Mechanistic Insight
Journal Title: Journal of Clinical and Molecular Endocrinology - Year 2017, Vol 2, Issue 1
Abstract
Glucose lowering efficacy was the basis for the approval of antihyperglycaemic drug in the past. However, increasing concerns emerged about potential cardiovascular side effects of these drugs following the metaanalysis of Nissen and Wolski published in 2007 describing a relative 43% increase in myocardial infarction with the thiazolidinedione rosiglitazone. Therefore, the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) are mandating cardiovascular outcome trials for all new antidiabetic drugs. As consequence more than 160 thousand subjects have been enrolled in cardiovascular outcome trials since 2008. Lowering the risk for macro vascular complications is one of the major tasks in current diabetes management. Thus, augmenting data on potential positive or negative cardiovascular side effects of antidiabetic drugs is of high value since many patients with diabetes have additional cardiovascular risk factors. Lately, beneficial effects have been proven for Liraglutide as well as Empagliflozin in these trials, whereas Saxagliptin tended to increase heart failure hospitalization. However, it has to be kept in mind that patients randomized in clinical outcome trials are commonly of increased cardiovascular risk to sufficiently power these trials whereas a relevant proportion of patients with diabetes do not have additional cardiovascular risk factors. This facilitates misinterpretations of the data, especially in those patients with lower cardiovascular risk.
Authors and Affiliations
Dirk von Lewinski
Keywords
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- EP ID EP305637
- DOI 10.21767/2572-5432.100037
- Views 41
- Downloads 0
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Antidiabetics and Heart Failure - Large Trials but Little Mechanistic Insight
Glucose lowering efficacy was the basis for the approval of antihyperglycaemic drug in the past. However, increasing concerns emerged about potential cardiovascular side effects of these drugs following the metaanalysis...