Table 1 Summary of common medications used in combination to alleviate the symptoms of DHD
Target | Drug class | Mechanism of action(s) | Primary outcome(s) | Associated outcome(s) | Ref. |
|---|---|---|---|---|---|
Blood glucose | Biguanides (e.g.: metformin) | Activates AMP kinase subunit beta-1 | Decreases blood glucose Decreases intestinal absorption of glucose Increases peripheral glucose uptake and utilization Lower hepatic gluconeogenesis Increases insulin sensitivity | Reduces all-cause mortality and CVD events Lower risk of heart failure | |
Glucagon-like peptide-1 (GLP-1) (e.g.: Exenatide, Liraglutide, Albiglutide) | Functional analog of the human incretin Glucagon-Like Peptide-1 (GLP-1) Activates GLP-1 receptor | Enhances glucose-dependent insulin secretion Reduces gastric emptying rate Reduces food intake | Reduces post-prandial glucose Reduces body weight Possibly reduces CVD risks | ||
Sulfonylureas (e.g.: Glimepiride, Glyburide, Glipizide) | Closure of ATP-sensitive inward rectifier potassium channel-1 and-11 on β-cells Closure of ATP-binding cassette sub-family C member 8 on β-cells | Decreases blood glucose Stimulates insulin secretion Increases peripheral insulin sensitivity | Decreases microvascular risks | ||
Thiazolidinediones (e.g.: Pioglitazone, Rosiglitazone) | Activates peroxisome proliferator activated receptors (PPAR) Regulates the transcription of insulin-responsive genes | Decreases blood glucose Increases insulin sensitivity | Increases high-density lipoprotein Decreases triglycerides Possibly reduces CVD risks | ||
Insulin (e.g.: Glulisine, Lispro, Aspart, Glargine, Detemir) | Activates insulin receptors (PI3K/Akt/PKC cascade) | Stimulates insulin-dependent glucose transporters Promotes glucose disposal Lower hepatic gluconeogenesis Reduces ketogenesis | Decreases microvascular risks | ||
Blood pressure | Angiotensin-converting enzyme (ACE) inhibitors (e.g.: Benazepril, Lisinopril, Enalapril, Fosinopril,) | Inhibits angiotensin-converting enzyme Suppresses the conversion of angiotensin-I to angiotensin-II | Reduces plasma angiotensin-I Reduces vasopressor activity Decreases aldosterone secretion Suppresses vasoconstriction Lower blood pressure | Adjunctive therapy for congestive heart failure May be used to delay the progression of renal disease | |
Calcium channel blockers (e.g.: Amlodipine, Lacidipine) | Inhibits influx of calcium ions on L-type calcium channels Decreases arterial smooth muscle contractility | Lower blood pressure Dilates coronary and systemic arteries Promotes coronary blood flow Decreases cardiac output | Adjunctive therapy for coronary syndrome | ||
Diuretics (e.g.: Polythiazide, Chlorothiazide, Chlorthalidone, Bumetanide) | Inhibits active chloride reabsorption Increases sodium and water excretion | Decreases preload Lower blood pressure | Adjunctive therapy for edema associated with congestive heart failure, hepatic and renal disease | ||
Beta blockers (e.g.: Atenolol, Metoprolol, Carvedilol, Nadolol, Acebutolol) | Inhibits β1-adrenegic receptor | Decreases heart rate Decreases cardiac output Lower blood pressure Suppresses vasoconstriction | Not primary hypertensive therapy Adjunctive therapy for heart failure Prevention for patients with underlying ischemic heart disease | ||
Blood cholesterol | Statin (e.g.: Atorvastatin, Simvastatin, Pravastatin, Fluvastatin) | Inhibits hepatic enzyme HMG-CoA reductase Inhibits cholesterol biosynthesis Increases hepatic uptake of LDL | Decreases total cholesterol, LDL, triglycerides, apolipoprotein B Increases HDL | Adjunctive therapy for CHD Primary prevention to reduce risk of myocardial infarction, stroke and coronary syndrome | |
Fibrates (e.g.:Gemfibrozil, Fenofibrate) | Increases the activity of extrahepatic lipoprotein lipase (LL) Increases lipoprotein triglyceride lipolysis Activates Peroxisome proliferator-activated receptor-alpha (PPARα) | Increases triglyceride clearance Decreases Chylomicrons, apolipoprotein B |  |