Potential beneficial effects of insulinsensitizing agents on cardiovascular risk factors

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Several epidemiologic studies showed that hyperinsulinemia is an independent risk factor for cardiovascular disease [18]. Correction of insulin resistance clearly is important in the management of type 2 diabetes mellitus and may decrease the risk for cardiovascular disease. In the UKPDS, patients who had type 2 diabetes melli-tus and were treated with metformin, which decreases hyperinsulinemia and insulin resistance, had a 30% reduction in cardiovascular disease events and mortality compared with those who received conventional treatment [11]. The thiazo-lidinediones also improve insulin sensitivity and may exert numerous nonglycemic effects in patients who have type 2 diabetes mellitus [19,20]. Additional clinical trials are being conducted to evaluate whether treatment of diabetes mellitus with agents that reduce insulin resistance, such as the thiazolidinediones, is superior to treatment with agents that stimulate insulin secretion, such as the sulfonylureas.

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