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Is it possible to reduce cardiovascular risk with glucose-lowering approaches?

Nature Reviews Endocrinology volume 5, pages 270–275 (2009)Cite this article

Abstract

Diabetes mellitus is a strong, independent risk factor for cardiovascular events, and a key determinant of the level of this risk is the degree of glucose elevation. Clinical trials have not demonstrated that lowering glucose levels in people with established, long-duration diabetes mellitus has a clear cardiovascular benefit, and one trial reported that this approach increased mortality. In individuals with recent-onset diabetes mellitus, however, control of glucose level has established benefits on diabetes-related eye disease and kidney disease (which are themselves cardiovascular risk factors), and 10 years of intensive glucose control in these patients reduces the 15–20-year risk of myocardial infarction and mortality. These observations, along with the facts that the prevalence of diabetes mellitus is growing and that people typically have the disease for 20–40 years of their lives, support the importance of controlling glucose level and preventing its progressive rise over time. Currently available evidence suggests that therapeutic efforts that target hyperglycemia early in the course of diabetes have a long-term cardiovascular benefit.

Key Points

  • Diabetes mellitus is an independent risk factor for cardiovascular disease

  • The degree of blood glucose elevation is an independent risk factor for cardiovascular disease in the general population, regardless of diabetes status

  • Completed clinical trials that examined intensive versus standard glycemic control in people with well-established diabetes mellitus have not proved whether either strategy has cardiovascular benefit

  • Intensive glycemic control in people with newly diagnosed diabetes mellitus reduces their long-term risk of cardiovascular disease

  • Several ongoing trials are assessing the effects that different agents or strategies used for lowering levels of glucose have on cardiovascular outcomes

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Figure 1: Completed and ongoing trials of glucose-lowering therapies in people with various degrees of dysglycemia.

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Acknowledgements

H. C. Gerstein holds the McMaster University Population Health Institute Chair in Diabetes Research (sponsored by Aventis).

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Authors and Affiliations

  1. Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada

    Hertzel C. Gerstein

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Correspondence to Hertzel C. Gerstein.

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The author declared associations with the following companies: Bayer, GlaxoSmithKline, Merck and Sanofi-Aventis (consultant and grant/research support).

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Gerstein, H. Is it possible to reduce cardiovascular risk with glucose-lowering approaches?. Nat Rev Endocrinol 5, 270–275 (2009). https://doi.org/10.1038/nrendo.2009.49

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