theres too little evidence on how diabetes drugs affect heart risk heres what you need to know creditchristopher capozziello for the new york timesjune 5 2017heart disease is the leading cause of death for people with type 2 diabetes surely then the way to dodge this bullet is to treat the disease and lower blood sugarwell maybe growing evidence suggests that the method by which blood sugar is lowered may make a big difference in heart risk that has raised a medical dilemma affecting tens of millions of people with type 2 diabetes and for the doctors who treat themsome diabetes drugs lower blood sugar yet somehow can increase the chances of heart attacks and strokes other medications have no effect on heart risk while still others lower the odds of heart disease but may have other drawbacks like high cost or side effectsits becoming clear researchers say that theres far too little evidence on how diabetes drugs affect the heart to make rational evidencebased judgments if you think the landscape is confusing it really is said dr leigh simmons an internist in bostondaunting is how dr joann manson the chief of preventive medicine at brigham and womens hospital describes the situation for patients and their doctors she explained the option and uncertainties in a recent commentary in jamathere are 12 classes of drugs on the market and two or three different agents in each class the drugs range in price from about 4 a month for older drugs to 700 a month for newer ones and they have varying side effects many patients take more than one drugthe older cheaper and more popular diabetes drugs were never tested for their effects on the heart they were approved before any links were noticeda particular drugs effect on blood sugar does not predict its effects on the heart even understanding the chemistry at work the drugs act in very different ways to lower blood sugar does not predict whether a particular medication will increase heart risk in a particular patient researchers saywe cant predict what happens to people just based on the mechanisms of these drugs said dr kasia j lipska a diabetes expert at yale university who wrote a recent paper on the issue we have to study large groups of patients and examine what drugs reduce complications of diabetes such as heart attacks and in which patientsbut that has rarely been done these drugs are already approved there is little incentive to do such expensive studies nowits a disgrace that so little is known said dr victor m montori a diabetes expert at the mayo clinicno one disputes the importance of lowering blood sugar when levels are very high doing so may help prevent complications like kidney disease nerve damage and damage to the eyes and may alleviate symptoms like fatigue and frequent urinationthe starting point for lowering blood sugar is diet and exercise but for many patients that is not sufficient then doctors and patients are faced with