ABSTRACT
Drugs used in the treatment of cardiovascular disorders and diabetes are among the most
commonly prescribed medications in the United States. Figures 1 and 2 show a classification
of cardiovascular and antidiabetic medications. Use of these agents has continuously
increased due to the improved recognition of these disorders and their complications.
Additionally, the ever-growing problem of obesity and the metabolic syndrome has caused
an increase in the incidence of diabetes, dyslipidemia, hypertension, and subsequent coronary
artery disease and dysrhythmias. There is high prevalence of nonalcoholic fatty liver disease
(NAFLD) and nonalcoholic steatohepatitis (NASH) in patients with obesity, diabetes, and
dyslipidemia, and distinguishing medication-induced liver disease from underlying liver
disease can be difficult. This leads to difficulty in distinguishing whether the liver disease is
due to cardiovascular or diabetic drugs themselves or is a manifestation of underlying liver
disease resulting from metabolic disorders and diabetes. Evolving data suggest that patients
with diabetes may have higher risk of drug-induced liver disease than nondiabetic individ-
uals. Diabetic patients who take oral hypoglycemics have a higher risk of developing drug-
induced liver disease than those not taking these medications (1,2). An excellent review was
recently published by Wang and colleagues that provided a detailed review of existing human
and animal studies supporting the notion that patients with diabetes are generally at higher
risk for developing drug hepatotoxicity (3).
