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Effects of glucose-lowering drugs in patients with diabetes and myocardial infarction

Linda G Mellbin , Klas Malmberg & Lars Ryden

Patients with diabetes have a higher risk for fatal and nonfatal complications of cardiovascular (CV) disease, and a worse prognosis following a CV event than patients without diabetes. Lowering glucose levels appears to prevent CV events in patients with newly detected diabetes, but data are conflicting in patients with longer diabetes duration and in patients with established CV disease. Furthermore, the optimal strategy for glucose lowering has not yet been defined, either in the setting of an acute CV event or for longterm glucose-lowering treatment. Recent data suggest that insulin may be associated with an increased rate of nonfatal myocardial infarctions in patients who have suffered an acute coronary event. This article provides an overview of the impact of different glucoselowering agents on CV morbidity and mortality, and on malignant diseases in patients with diabetes and myocardial infarction.