The cardiologist's role in the management of type 2 diabetes-a review

Evidence-based medicine is key to the cardiologist's role in the management of type 2 diabetes. Proven therapies that reduce cardiovascular (CV) events with few off-target effects are imperative. Evidence from epidemiology studies supports the concept that increased blood sugar is correlated with increased CV events. Unfortunately, the lowering of glucose with current agents shows limited benefit in reducing CV events. Metformin in the obese individual reduced CV events and is currently first-line therapy in most clinical practice guidelines. Recently, a meta-analysis reported that current hypoglycemic agents did not improve CV outcomes and were possibly harmful. Possible exceptions come from the Prospective pioglitazone clinical trial in macrovascular events (PROactive), a secondary prevention trial in patients with prior myocardial infarction in which pioglitazone was found to reduce CV events. Glucagon-like peptide-1 (GLP-1) agonists appear to be the most exciting new CV agents, but a dipeptidyl peptidase-4 (DPP4) inhibitor (sitagliptin) combined with a high-dose angiotensin-converting enzyme inhibitor (ACEI) (enalapril) may increase blood pressure and heart rate. Lifestyle modification and proven global risk reduction are still the number one ways to reduce CV events in type 2 diabetes.