The guidance issued to the pharmaceutical industry by the US Food and Drug Administration in 2008 has led to the publication of a series of randomized, controlled cardiovascular outcomes trials with newer therapeutic classes of glucose-lowering medications. Several of these trials, which evaluated the newer therapeutic classes of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, have reported a reduced incidence of major adverse cardiovascular and/or renal outcomes, usually relative to placebo and standard of care. Metformin was the first glucose-lowering agent reported to improve cardiovascular outcomes in the UK Prospective Diabetes Study (UKPDS) and thus became the foundation of standard care. However, as this clinical trial reported more than 20 years ago, differences from current standards of trial design and evaluation complicate comparison of the cardiovascular profiles of older and newer agents. Our article revisits the evidence for cardiovascular protection with metformin and reviews its effects on the kidney.

中文翻译：

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二甲双胍和糖尿病的心肾结局：重新评估。


美国食品和药物管理局 2008 年向制药行业发布的指导意见导致发表了一系列采用新型降糖药物治疗的随机、对照心血管结果试验。其中一些试验评估了钠-葡萄糖协同转运蛋白 2 抑制剂和胰高血糖素样肽 1 受体激动剂的新治疗类别，报告称主要不良心血管和/或肾脏结局的发生率通常相对于安慰剂有所降低和护理标准。在英国前瞻性糖尿病研究 (UKPDS) 中，二甲双胍是第一种被报道可改善心血管结局的降糖药物，因此成为标准治疗的基础。然而，正如该临床试验 20 多年前报道的那样，与当前试验设计和评估标准的差异使旧药和新药心血管特征的比较变得复杂。我们的文章重新审视了二甲双胍保护心血管的证据，并回顾了其对肾脏的影响。