至今只有有限的研究顯示降血糖藥物能減少冠狀動脈疾病，其中最經典的研究是英國的UKPDS研究，使用雙胍類(Biguanides)，磺醯尿素類(Sulfonylurea) 與胰島素(Insulin)在長期追蹤的研究中發現可降低心血管疾病發生率。新一代藥物中Thiazolidinedione(TZD) 類衍生物在心血管疾病的角色最受爭議，上市後Rosiglitazone 即因會伴隨增加心血管疾病而下市。阿爾發葡萄糖苷酶抑制劑(α-glucosidase inhibitors)對於心血管的臨床預後尚無一致性的結論，需要更多資料來佐證。DPP-4 抑制劑(Dipeptidyl Peptidase-IV Inhibitors)與第1型類昇糖素胜肽(GLP-1) 是最近研發的藥物，近期小型的研究顯示DPP-4 與GLP-1 可能能夠改善一些心血管疾病的監測指標(surrogate markers) 。近期ACCORD與VADT研究都不支持要將HbA1c 降至6.5%以下，這些積極降血糖的研究都發現，病人心血管疾病沒下降，但低血糖的危險性與死亡率會上升。血糖控制應該以病人為中心的方式(A Patient-Centered Approach) ，著重個別化的治療(individualization of treatment)；因此以心臟科醫師的立場處方降血糖藥物，就降低心血管疾病的目的來看，對高心血管風險或已經確診心血管疾病的糖尿病病人，採取傳統標準治療至HbA1C < 7%即可。藥物的建議使用仍然是以雙胍類為首選，至於DPP-4 抑制劑與GLP-1 類對心血管疾病是否有所助益，可能須看未來幾年的研究而定了。

Only limited studies have shown that anti-diabetic drugs could reduce the mortality and morbidity associated with coronary artery disease (CAD), of which is the United Kingdom Prospective Diabetes Study (UKPDS) regarding with the use of biguanides, sulfonylurea, and insulin in the long-term follow-up. Thiazolidinedione (TZD) is controversial especially when Rosiglitazone associated with an increase in the risk of cardiovascular deaths. There is a lack of consistent conclusions on the cardiovascular outcomes for α-glucosidase inhibitors and further studies are needed. Dipeptidyl Peptidase-IV Inhibitor (DPP-4 inhibitor) and Glucagon-like peptide-1 (GLP-1) are developed recently, which are capable of improving some cardiovascular surrogate markers. ACCORD and VADT studies do not support the intensive sugar control with a target HbA1c of 6.5% or less, which may increase the risk of hypoglycemia and mortality without any decrease in cardiovascular disease (CVD). Management of hyperglycemia should be based on a patient-centered approach with emphasis on individualization of treatment. To reduce CVD from a cardiologist's point of view, a simply target HbA1c of 7.0% is adequate for patients with high cardiovascular risk or diagnosed CVD and the biguanides is preferred. For DPP-4 and GLP-1, further research is required to evaluate the potential benefit in CVD.