Diabète de type 2, antidiabétiques oraux et complications cardiovasculaires

Besides their antihyperglycemic effect, different antihyperglycemic drugs, even from the same drug class, may have different effects on cardiovascular events and mortality. From available data from the literature (randomized trials, registers, and meta-analysis), it can be concluded that metformin exerts a cardiovascular protective effect, reducing mortality and cardiovascular outcomes in T2DM patients. First generation sulphonylureas (glibenclamide, chlorpropamide) have been shown to be associated in the long-term (18-20 years) to a reduction in mortality and cardiovascular outcomes. Second generation sulphonylurea gliclazide is likely to exert a more important protective effect than older sulphonylureas. Available data are insufficient to conclude for other drug classes, such as glinides and inhibitors of α-glucosidases. Long-term clinical data are lacking for DPP-4 inhibitors and GLP-1 analogs, as trials are in progress, but a favourable effect of these drugs has been reported upon classic and non-classic cardiovascular risk factors.