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Antidiabetic Agents May Harm the Heart in Non-Diabetics
Antidiabetic Agents May Harm the Heart in Non-Diabetics -- Posted by Gumbo on 05-06-05 04:52
Antidiabetic Agents May Harm the Heart in Non-Diabetics
NEW YORK (Reuters Health) - In a study of non-diabetic African Americans
with insulin resistance, the long-term use of oral antidiabetic agents was
associated with an increase in aortic pulse wave velocity (PWV), which is
consistent with a decrease in the elastic properties of the aorta.
"It has been shown previously that increased PWV is an indicator of a high
incidence of cardiovascular events and an independent predictor of cardiac
mortality," study investigators note in the May issue of the journal Heart.
Therefore, "the use of oral antidiabetic agents for the prevention of
cardiovascular complications in non-diabetic African Americans with insulin
resistance needs to be critically evaluated," they conclude.
It has been suggested that improving insulin sensitivity, perhaps with oral
antidiabetic agents, in insulin resistant non-diabetic individuals may delay
the development of diabetes and its related cardiovascular complications.
But data are lacking on the long-term cardiovascular effects of these agents
in non-diabetic populations.
To investigate, Dr. Harisios Boudoulas from the Academy of Athens in Greece
and associates randomly assigned 181 normoglycemic African Americans, but
with insulin resistance, to glipizide (5 mg/day), metformin (500 mg/day) or
placebo for 24 months.
They observed a significant increase in aortic PWV in both glipizide-
and metformin-treated subjects, with p values of 0.012 and 0.01,
respectively. In contrast, aortic PWV remained unchanged in the placebo arm.
The increase in PWV in the two active treatment arms was significant
relative to placebo (analysis of variance p < 0.05).
"No other cardiovascular or metabolic variable changed significantly during
the follow up period," they note.
In a multivariate analysis, treatment with glipizide or metformin "was the
only independent predictor of changes in PWV during the follow up period."
The investigators note that the precise mechanism or mechanisms responsible
for the effects of these agents on aortic function are unknown and deserve
further study.
Heart 2005;91:589-594.
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