Long-term changes in cardiovascular risk markers during administration of exenatide twice daily or glimepiride: results from the European exenatide study

Objective The risk of cardiovascular morbidity and mortality is significantly increased in patients with diabetes; thus, it is important to determine whether glucose-lowering therapy affects this risk over time. Changes in cardiovascular risk markers were examined in patients with type 2 diabetes tr...

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Bibliographic Details
Published in:Cardiovascular diabetology Vol. 14; no. 1; p. 116
Main Authors: Simó, Rafael, Guerci, Bruno, Schernthaner, Guntram, Gallwitz, Baptist, Rosas-Guzmàn, Juan, Dotta, Francesco, Festa, Andreas, Zhou, Ming, Kiljański, Jacek
Format: Journal Article
Language:English
Published: London BioMed Central 04.09.2015
Subjects:
Aged
Angiology
Biomarkers - blood
Blood Glucose - drug effects
Blood Glucose - metabolism
Blood Pressure - drug effects
C-Reactive Protein - metabolism
Cardiology
Cardiovascular Diseases - blood
Cardiovascular Diseases - diagnosis
Cardiovascular Diseases - etiology
Cardiovascular Diseases - physiopathology
Cardiovascular Diseases - prevention & control
Diabetes
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - physiopathology
Drug Administration Schedule
Drug Therapy, Combination
Europe
Exenatide
Female
Glycated Hemoglobin - metabolism
Heart Rate - drug effects
Humans
Hypoglycemic Agents - administration & dosage
Hypoglycemic Agents - adverse effects
Incretins - administration & dosage
Incretins - adverse effects
Lipids - blood
Male
Medicine
Medicine & Public Health
Metformin - administration & dosage
Middle Aged
Original Investigation
Peptides - administration & dosage
Peptides - adverse effects
Risk Factors
Sulfonylurea Compounds - administration & dosage
Sulfonylurea Compounds - adverse effects
Time Factors
Treatment Outcome
Venoms - administration & dosage
Venoms - adverse effects
Type 2 diabetes
Exenatide twice daily
High-sensitivity C-reactive protein
GLP-1 receptor agonist
Cardiovascular risk
ISSN:1475-2840, 1475-2840
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Summary:Objective The risk of cardiovascular morbidity and mortality is significantly increased in patients with diabetes; thus, it is important to determine whether glucose-lowering therapy affects this risk over time. Changes in cardiovascular risk markers were examined in patients with type 2 diabetes treated with exenatide twice daily (a glucagon-like peptide-1 receptor agonist) or glimepiride (a sulfonylurea) added to metformin in the EURopean EXenAtide (EUREXA) study. Research design and methods Patients with type 2 diabetes failing metformin were randomized to add-on exenatide twice daily (n = 515) or glimepiride (n = 514) until treatment failure defined by hemoglobin A1C. Anthropomorphic measures, blood pressure (BP), heart rate, lipids, and high-sensitivity C-reactive protein (hsCRP) over time were evaluated. Results Over 36 months, twice-daily exenatide was associated with improved body weight (−3.9 kg), waist circumference (−3.6 cm), systolic/diastolic BP (−2.5/−2.6 mmHg), high-density lipoprotein (HDL)-cholesterol (0.05 mmol/L), triglycerides (−0.2 mmol/L), and hsCRP (−1.7 mg/L). Heart rate did not increase (−0.3 beats/minute), and low-density lipoprotein-cholesterol (0.2 mmol/L) and total cholesterol (0.1 mmol/L) increased slightly. Between-group differences were significantly in favor of exenatide for body weight ( P  < 0.0001), waist circumference ( P  < 0.001), systolic BP ( P  < 0.001), diastolic BP ( P  = 0.023), HDL-cholesterol ( P  = 0.001), and hsCRP ( P  = 0.004). Fewer patients randomized to exenatide twice daily versus glimepiride required the addition of at least one antihypertensive (20.4 vs 26.4 %; P  = 0.026) or lipid-lowering medication (8.4 vs 12.8 %; P  = 0.025). Conclusions Add-on exenatide twice daily was associated with significant, sustained improvement in several cardiovascular risk markers in patients with type 2 diabetes versus glimepiride. Clinical trial registration: NCT00359762, http://www.ClinicalTrials.gov
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ISSN:1475-2840
1475-2840
DOI:10.1186/s12933-015-0279-z