A review of metabolic and cardiovascular effects of oral antidiabetic agents: beyond glucose-level lowering

It has become evident that cardiovascular disease is the major cause of mor bidity and mortality in type 2 diabetes mellitus. This raises the possibili ty that glucose lowering agents with other nonglucose-lowering effects, mig ht have added benefits. In this review, we focus on the metabolic and cardi ovascular effects of oral antidiabetic agents that go beyond glucose-level lowering. Such effects include lipid modifying actions, antithrombotic and profibrinolytic activities, and direct action at the level of the vessel wa ll to improve endothelial function or prevent smooth muscle hyperplasia. Th ese additional activities, particularly those seen with the newer oral anti diabetic agents, hold the promise of reducing cardiovascular complications beyond that achievable by glucose lowering alone. (C) 1999 Lippincott Willi ams & Wilkins.