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STATE-OF-THE-ART PAPER

Cardiovascular Therapies and Associated Glucose Homeostasis

Implications Across the Dysglycemia Continuum

Rhonda M. Cooper-DeHoff, PharmD, MS^_*,_*, Michael A. Pacanowski, PharmD, MPH and Carl J. Pepine, MD, MACC^_*

^_* Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida
Department of Pharmacy Practice and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida

Manuscript received April 7, 2008; revised manuscript received October 27, 2008, accepted October 28, 2008.

^_* Reprint requests and correspondence: Dr. Rhonda M. Cooper-DeHoff, Division of Cardiovascular Medicine, University of Florida College of Medicine, P.O. Box 100277, Gainesville, Florida 32610-0277 (Email: dehofrm{at}medicine.ufl.edu).

Certain cardiovascular drugs have adverse effects on glucose homeostasis, which may lead to important long-term implications for increased risks of adverse outcomes. Thiazide diuretics, niacin, and beta-adrenergic blockers impair glucose homeostasis. However, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have demonstrated beneficial metabolic effects. The newer vasodilating beta-blocking agents and calcium antagonists appear to be metabolically neutral. These considerations, in addition to meticulous attention to blood pressure control and lifestyle changes, have the potential to beneficially modify glycemia and long-term risks. These considerations have particular importance in younger patients who may also have pre-diabetes or the metabolic syndrome and who are likely to require therapy over the course of decades.

Key Words: metabolic syndrome • pre-diabetes • thiazide diuretic • dysglycemia • glucose homeostasis

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ARB = angiotensin receptor blocker   BP = blood pressure   CAD = coronary artery disease   CHD = coronary heart disease   CV = cardiovascular   HDL-C = high-density lipoprotein cholesterol   IFG = impaired fasting glucose   IGT = impaired glucose tolerance   MetSyn = metabolic syndrome   RAAS = renin-angiotensin-aldosterone system

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