Last update:
06-Dec-2017

It is well known that cardiovascular (CV) disease is the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (DM). In recent years, a topic of frequent discussion is the CV safety of antidiabetic medications. The data on the CV safety of the older antidiabetic agents are based mainly on randomized controlled trials designed to assess their glucose lowering efficacy. This is a review of current knowledge about the CV safety of the newer antidiabetic medications. According to the current guidelines, metformin is the first line agent for the treatment of type 2 DM and it appears to have cardio-protective effects. When metformin monotherapy fails to achieve HbA1c targets, the choice of the second line agent is less clear. Based on the findings of the EMPA-REG OUTCOME trial and the recently published LEADER and SUSTAIN-6 trials, empagliflozin, liraglutide and semaglutide appear to be reasonable options for patients with CV disease, as these agents are associated with a reduction in CV morbidity and mortality. For individuals without CV disease, any of the other classes of antidiabetic medication can be selected, using a patientcentered approach. Saxagliptin, alogliptin, sitagliptin and lixisenatide have all been evaluated in CV safety trials and found to have neutral effects on CV outcome, although it is recommended that saxagliptin and alogliptin should be avoided for patients with heart failure.

Key words: Cardiovascular safety, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, Type 2 diabetes mellitus.