Cardiovascular risks in type 2 diabetes and the interpretation of cardiovascular outcome trials

Abstract

Background

Patients with type 2 diabetes (T2D) are at increased cardiovascular (CV) risk compared to subjects without diabetes, with some data estimating that CV disease (CVD) risk is doubled in these individuals. Additionally, CVD remains the leading cause of death in patients with T2D, so it is paramount to determine the relationship between these two diseases.

Purpose

Older diabetes treatments have limited CV safety data. In 2008, the US Food and Drug Administration published guidance for manufacturers on antihyperglycemic agents, requiring studies to ensure CV safety of new therapies. Since then, manufacturers of many newer agents have conducted and published results from CV outcomes trials (CVOTs), with more trials due to publish soon. This review discusses the relationship between CVD and T2D and explores findings from the latest CVOTs of glucose-lowering agents to guide nurse practitioners in their prescribing patterns for patients with T2D.

Conclusion

Patients with T2D are at high risk of CVD, so CV risk should be carefully considered when managing these patients, and CV risks and benefits of antidiabetic drugs should be included in prescribing decisions.

Keywords:

• cardiovascular disease
• chronic disease management
• type 2 diabetes mellitus
• nurse practitioners

Acknowledgments

The authors are grateful to Kate Booth, BSc, of Watermeadow Medical, an Ashfield company, for writing assistance in the development of this manuscript. This assistance was funded by Novo Nordisk, who also had a role in the review of the manuscript for scientific accuracy.

Disclosure

Deborah Hinnen has attended advisory boards for Janssen Pharmaceuticals, Sanofi, Eli Lilly and Co, and Novo Nordisk and has served on speakers’ bureau for Eli Lilly and Co and Janssen Pharmaceuticals. Davida F Kruger has attended advisory boards for Janssen Pharmaceuticals, Abbott, Boehringer Ingelheim, Dexcom, Eli Lilly and Co, Novo Nordisk, and Sanofi Aventis; has served on speakers’ bureau for Boeh-ringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Co, Janssen Pharmaceuticals, Novo Nordisk, and Valeritas; and has received research support from Abbott, Bristol-Myers Squibb, Calibra/Johnson and Johnson, Dexcom, Eli Lilly and Co, IDC, Helmsley Charitable Trust, Lexicon, NIH, Novo Nordisk, and TEVA. The authors report no other conflicts of interest in this work.