Diabetes increases the risk of cardiovascular diseases. While improving glycemic control has been demonstrated to reduce microvascular complications, the benefits in reducing macrovascular complications have been controversial. This article reviews the published evidence assessing the benefits and risk of antidiabetic agents as related to cardiovascular outcomes. Current literature revealed that metformin and α-glucosidase inhibitors are the two agents that have not been associated with any harm in diabetic patients in terms of cardiovascular events. Clinical studies have demonstrated controversial results in the use of insulin, sulfonylureas, and thiazolidinediones and cardiovascular outcomes. However, the results may be affected by other unknown confounders, the comparative agents, and the degree of control of other cardiovascular risk factors. Clinicians should choose antidiabetic therapy based on patient specific parameters such as current glycemic control, and other concurrent disease states such as heart failure.
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