Potential Drug Combinations to Reduce Cardiovascular Disease Burden in Diabetes

The major cause of death and complications in patients with type 2 diabetes (T2DM) is cardiovascular disease (CVD). More than 60% of all patients with T2DM die of CVD, and an even greater percentage have serious complications. The impact of glucose lowering on cardiovascular complications is a hotly debated issue and recent large clinical trials reported no significant decrease in cardiovascular events with intensive glucose control. Risk remains high even after correcting diabetes-associated dyslipidemia with drugs such as fibrates and niacin. Data from several clinical studies show that postprandial glucose and lipids have a strong predictive value on myocardial infarction (MI) and mortality. However, strategies to reduce postprandial hyperglycemia and/or lipemia through increased utilization of glucose and/or triglycerides (TG) have been shown to not be effective in reducing the CVD burden. In this review, I discus the preferred ways to reduce postprandial glucose and TG with combinations of currently marketed drugs with potential benefit in CVD.

TrendsLowering plasma TG or increasing high-density lipoprotein (HDL) do not seem to offer benefits above the standard of care in diabetics.Therapeutic targets that prevent glucose and lipid absorption appear to be promising in reducing CVD burden in patients with diabetes.Emerging data suggest that mechanisms that promote glucose removal through the kidney appear to show cardiovascular and mortality benefits in patients with diabetes.Reducing sustained vascular stress under postprandial conditions is a promising therapeutic approach to reduce cardiovascular disease burden in patients with diabetes.