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- May 16, 2008 |
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"Oral Hypoglycemic Agents and Cardiac Events: The Good the Bad and the Ugly"Dr. David S.H. Bell (biography)
English - 2006-04-28 - 62 minutes
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 | (30 slides) |
 | (44 slides) |
Summary :
In this presentation Dr. Bell talks about different classes of antidiabetic agents, their effects, tolerability and impact on cardiac risk.
Do sulfonylureas increase the risk of cardiac events? Sulfonylureas work by closing the ATP-sensitive K+ channels in the wall of the pancreatic beta cell, leading to depolarization, an influx of calcium and an increased release of insulin. Closure of these ATP-sensitive K+ channels in the heart with traditional sulfonylureas can however lead to a loss of ischemic preconditioning (1). Dr. Bell discusses the role of these channels in ischemic preconditioning, how their activity is affected by different sulfonylureas and diabetes, and which sulfonylureas are safer to use. Some studies have also looked at the effects of sulfonylurea treatment on mortality in patients with type 2 diabetes (2-6).
Postprandial glucose has been found to be a predictor of cardiovascular risk (7). Dr. Bell reviews findings from the STOP-NIDDM trial of reduced cardiac events in acarbose-treated individuals with IGT and diabetes, and discusses targets for postprandial glucose levels.
Metformin was also shown in the UKPDS to lower cardiac events in overweight patients with type 2 diabetes, and findings from the more recent PROactive study indicate that thiazolidinediones may also decrease cardiac events however more outcome studies are needed. Dr. Bell talks about the effects and mechanisms of these insulin sensitizers that contribute to cardioprotection, and the possible beneficial role of treatment with insulin sensitizers in patients with heart failure.
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Ischemic preconditioning in the heart: effects of SUs and diabetes
- Studies on SU treatment and mortality in type 2 diabetes
- Decreased cardiac events associated with α-glucosidase inhibitor and metformin use
- Effects of TZDs in lowering cardiac risk factors and surrogate markers of atherosclerosis
- Evidence for possible benefit of lowering insulin resistance in heart failure
Bibliographic references :
1. Bell, DSH. Do sulfonylurea drugs increase the risk of cardiac events? CMAJ. 2006 Jan 17;174(2):185-6.
2. Garratt KN, Brady PA, Hassinger NL, Grill DE, Terzic A, Holmes DR Jr.
Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction J Am Coll Cardiol. 1999 Jan;33(1):119-24.
3. UGDP.Diabetes (1970);19:789-826.
4. Jeffrey A. Johnson, PHD, Sumit R. Majumdar, MD, MPH, FRCPC, Scot H. Simpson, PHARMD and Ellen L. Toth, MD, FRCPCDecreased Mortality Associated With the Use of Metformin Compared With Sulfonylurea Monotherapy in Type 2 Diabetes Diabetes Care 25:2244-2248, 2002.
5. Scot H. Simpson, Sumit R. Majumdar, Ross T. Tsuyuki, Dean T. Eurich and Jeffrey A. Johnson Dose–response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study CMAJ. 2006 Jan 17;174(2):169-74.
6. Matteo Monami, Chiara Luzzi, Caterina Lamanna, Veronica Chiasserini, Filomena Addante, Carla Maria Desideri, Giulio Masotti, Niccolò Marchionni, Edoardo MannucciThree-year mortality in diabetic patients treated with different combinations of insulin secretagogues and metformin Diabetes Metab Res Rev. 2006 Apr 24.
7. Ceriello A, Hanefeld M, Leiter L, Monnier L, Moses A, Owens D, Tajima N, Tuomilehto J.Postprandial glucose regulation and diabetic complications. Arch Intern Med. 2004 Oct 25;164(19):2090-5.
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