Michael Gejl et al. International Journal of Cardiology. Doi: 10.1016/j.ijcard.2014.11.096
Following the withdrawal of rosiglitazone, there is great interest in the impact of anti-diabetes medications on cardiovascular (CV) risk. The FDA and EMA now mandate that new hypoglycaemic medications undergo cardiovascular outcomes trials (CVOTs); this has extended to insulins with the DEVOTE study comparing degludec and glargine. It is estimated that 150,000 patients have been enrolled in these studies. Two CVOTs published last year, indicating no increased CV events for alo- and saxagliptin, however, an increase in hospitalisation for heart failure was seen for the latter. Whilst awaiting outcomes from other CVOTs, investigators are interrogating routinely collected data. This study analyses 10,073 patients (over 65,000 person-years) from the Danish National Hospital Discharge Register. It reports that metformin and liraglutide were associated with reduced CV outcomes. Encouraging but caution is indicated; real-life data have consistently suggested a reduced CV risk for gliptins, thus far not supported by CVOTs. Having said this, the design of the CVOTs may not allow any superiority of new therapies to emerge. At the end of all this effort and expense, we may be none-the-wiser….