Abstract
Non-insulin dependent diabetes mellitus carries a markedly elevated risk of cardiovascular
disease. For that reason the efficacy of any treatment modality for this disease should
be assessed in terms of the known cardiovascular risk factors, as for example serum
lipids. Sulfonylurea do not affect serum lipid levels to any significant extent. These
drugs promote β-cell secretion by closing potassium ion channels. These channels are
also present in vascular smooth muscle cells. Some, though not all, sulfonylureas
are able to inhibit the vascular dilatory response to potassium ion openers, thereby
adversely affecting the cardioprotective vascular response to ischaemia. Sulfonylureas,
in contrast to insulin, seem able to inhibit the fibrinolytic system, possibly via
the stimulating effect of proinsulin on the endothelial PAI-1 expression. These observations
need further confirmation. Of clinical importance is the frequent occurrence of hypoglycaemia
for which several risk factors are recognized.
Key words
Sulfonylurea - NIDDM - Hypoglycaemia - Potassium Ion Channels - Vascular Potassium
Ion Channels - PAI-1 - Fibrinolysis - Proinsulin
