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Cardiovascular Therapies and Associated Glucose Homeostasis: Implications Across the Dysglycemia Continuum

https://doi.org/10.1016/j.jacc.2008.10.037Get rights and content
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Certain cardiovascular drugs have adverse effects on glucose homeostasis, which may lead to important long-term implications for increased risks of adverse outcomes. Thiazide diuretics, niacin, and beta-adrenergic blockers impair glucose homeostasis. However, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have demonstrated beneficial metabolic effects. The newer vasodilating beta-blocking agents and calcium antagonists appear to be metabolically neutral. These considerations, in addition to meticulous attention to blood pressure control and lifestyle changes, have the potential to beneficially modify glycemia and long-term risks. These considerations have particular importance in younger patients who may also have pre-diabetes or the metabolic syndrome and who are likely to require therapy over the course of decades.

Key Words

metabolic syndrome
pre-diabetes
thiazide diuretic
dysglycemia
glucose homeostasis

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
ARB
angiotensin receptor blocker
BP
blood pressure
CAD
coronary artery disease
CHD
coronary heart disease
CV
cardiovascular
HDL-C
high-density lipoprotein cholesterol
IFG
impaired fasting glucose
IGT
impaired glucose tolerance
MetSyn
metabolic syndrome
RAAS
renin-angiotensin-aldosterone system

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This work supported in part by National Institutes of Health grant (5K23HL086558). Drs. Cooper-DeHoff and Pacanowski have no conflicts of interest to report. Dr. Pepine has received grant/research support from or has consultant agreements with AstraZeneca, Boehringer Ingelheim, CV Therapeutics Inc, Pfizer Inc, sanofi-aventis, Schering-Plough, Daiichi Sankyo Inc, Eli Lilly and Company, and Merck & Co. Inc.