Sulfonylurea drugs and risk of cardiovascular complications - much ado about nothing?


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Abstract

Cardiovascular complications are the main causes of mortality in patients with type 2 diabetes mellitus. Importance of accurate glycemic control aimed to prevention of these complications is proved. However, the use of some oral hypoglycemic agents, particularly sulfonylurea derivates (SUD), is accompanied by increase of cardiovascular risk, which can be explained by closure of ATP-dependent potassium channels. Whereas in the pancreas this mechanism leads to the stimulation of insulin secretion, it suppresses the phenomenon of ischemic preconditioning in the heart - an endogenous cardioprotective mechanism for prevention of fatal myocardium infarct. However, the effects of SUD on KATP channels in experimental studies are contradictory, and their clinical significance is not clear. Despite the structural differences in SUD and their varying ability to binding to the heart KATP channel receptor, to date there is no clinical evidences allowing to confirm the benefits of cardioprotective effect of any given SUD. This review is concerned with issues of molecular and cellular pharmacodynamics of SUD and data for their effects on the heart in patients with diabetes mellitus, with particular emphasis on glibenclamide - the most widely used SUD, which has the highest affinity for the KATP channel receptors in heart.

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L V Nedosugova

L Nedosugova

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