Do you exercise? That’s great. But if you sit down for most of the rest of your day, that’s a problem. You need to be active all day long. Little bursts count. If you have a desk job, take a short walk every hour to boost your circulation, even if it’s just to your break room and back. Binge-watching your favorite show? Get up and dance, or do push-ups during the commercials.
2. You Say ‘I’m Too Young’
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Don’t wait to work on keeping your heart healthy. Exercise, eat a healthy diet, and know your numbers — blood pressure, cholesterol, and blood sugar. The ideal time to do your heart a favor is now.
3. One Drink Too Many
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For most people, moderate drinking (one a day for women, up to two daily for men) is OK. A daily drink may even have some benefits for the heart. But more than that can raise levels of certain fats in the blood, and raise blood pressure, too. That’s especially true if you have several drinks at a time. So stick to your daily limit.
4. You Dis a Good-for-You Diet
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You may think it’s going to be all oat bran, all the time. Surprise! There’s no reason for your food to be bland and boring. A Mediterranean-style diet has delicious foods like olive oil, nuts, fruit, whole grains, fish, lean protein, and red wine. It helps keep your heart healthy, thanks to the “good” fats, fiber, and nutrients. Plus, you’ll actually want to stick to this diet because it tastes so good!
5. You Don’t Know Your Numbers
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Pop quiz: What’s your cholesterol level? How about your blood pressure? No clue? That’s risky. They could be too high without you knowing. (You could feel just fine and have high cholesterol or high blood pressure.) So protect yourself. Starting at age 20, make sure you see your doctor regularly and create a plan to check and track your numbers.
6. Waist Not
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Belly fat is particularly bad for your heart. So get your tape measure and size up the inches around your waist. It’s a red flag if it’s more than 35 inches around for women or 40 inches for men. Need to slim down? Take it step by step. Even losing a small amount of weight is good for your heart.
7. You Ignore Your Blues
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When you feel low, it’s hard to do things that are good for you, like exercise. If you have felt down for more than a few weeks, talk to your doctor or a mental health professional. Talk therapy, exercise, and medication (if needed) can improve your mood so you have more energy to take care of yourself.
8. You Blow Off Secondhand Smoke
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Someone else’s smoke could hurt your heart and blood vessels. You need to avoid it. If you spend a lot of time with someone who isn’t ready to quit smoking, insist that they at least not smoke around you, whether it’s at home, work, or in your car. Your tough love may be the nudge they need to kick the habit, which will be good for both of you.
Napping isn’t just for babies. Studies show that an afternoon nap is great for adults, too. There’s no need to feel lazy for indulging in daytime sleep. A short nap in the mid-afternoon can boost memory, improve job performance, lift your mood, make you more alert, and ease stress. Cozy up to these nap benefits.
It Can Improve Your Memory
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Studies have shown that sleep plays an important role in storing memories. A nap can help you remember things learned earlier in the day as much as a full night’s sleep. Napping works to keep you from forgetting things like motor skills, sense perception, and verbal recall, too.
You May Be Able to Connect the Dots Easier
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Not only can napping help you remember things you’ve just learned, but it could help your brain draw connections between things you find out. In one study, nappers found it easier to put together information they got earlier in the day.
It Might Help You Climb the Corporate Ladder
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When you do a task over and over throughout the day, your performance gets worse as the day goes on. Studies show that a nap can help keep you more consistent.
It May Lift Your Mood
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If you’re feeling down, try taking a nap to lift your spirits. Napping, or even just resting for an hour without falling asleep, can brighten your outlook. Experts say relaxation that comes from lying down and resting is a mood booster, whether you fall asleep or not.
Need to Be More Alert? Nap
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If you start to feel a bit sleepy right after lunch, you’re not alone. The post-lunch struggle is real. A 20-minute nap can help you battle heavy eyelids.
Small Naps Bring Big Benefits
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A nap as short as 10 minutes can be beneficial, but keep your nap to 30 minutes or less so you don’t wake up feeling more tired. That grogginess you can feel after a nap is called sleep inertia. The longer you nap, the more likely you are to have that feeling. The worse it is, the more time you’ll need to wake up and transition back to work.
Naps are Better Than Caffeine
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If you’re feeling tired but have work or studying to get done, you may be better off taking a nap than sipping a coffee. Compared to caffeine, napping can bring better memory and learning.
Long Night Ahead? A Nap Can Help
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If you know you won’t get much sleep for a night or two (due to travel, for example) you’re better off preparing with a nap ahead of time than powering through with caffeine. The longer the nap, the better. If you have to resort to caffeine, drinking small amounts often is better than one large cup of joe.
They Can Ease Stress
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If you’re under a lot of pressure, a nap can release stress and improve your immune health. Experts believe that a 30-minute nap can do the trick.
They’re Good for Your Heart
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A nap can even help your ticker. A study found that people who napped for 45 to 60 minutes had lower blood pressure after going through mental stress. So a nap can help your body recover from pressure-filled situations.
They Can Make You More Creative
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Ever wake up with a great idea? REM sleep, which typically starts 70 to 90 minutes after you fall asleep, activates parts of your brain associated with imagery and dreaming. A nap with REM sleep can help you combine ideas in new ways to come up with answers.
Naps Can Help You Sleep Better at Night
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Although it may seem illogical, taking a nap during the day can help older adults improve sleep at night. Studies show a 30-minute nap between 1 p.m. and 3 p.m. combined with moderate exercise, like a walk and stretching in the evening, helps improve nighttime sleep. Mental and physical health can get better, as well.
They Can Help Your Little Ones, Too
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Many preschool-age children stop napping long before they enter kindergarten. Fact is, naps are critical for learning and development at that age. Children who nap regularly are better able to recall things they learned. Since short-term memory stores are limited at that age, younger kids need more frequent sleep. It’s an important part of how the brain hangs on to memories.
Make Them a Habit
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While certain benefits of napping can be had by anyone, there’s some evidence that naps only improve certain types of learning when the person takes them regularly. This includes the ability to tell the difference between similar things like images or textures.
When Should You Nap?
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To get the most benefits out of a nap, you need to time it right. Most people will find an afternoon snooze to be the most natural and helpful. Some say sleep is better between 2 and 3 p.m., when humans naturally have a dip in alertness. The time that works best for you will depend on how rested you are to begin with. If you’re well-rested, a slightly later nap is better. If you’re behind on sleep, you’ll want to nap earlier.
The holiday season is filled with to-do lists, but one should rise to the top: Take care of your heart.
Whether from stress, cold weather or falling out of good habits in terms of eating, sleeping and drinking, heart attack rates spike as much as 40% between Christmas and New Year’s, according to cardiologist Dr. Donald Lloyd-Jones. He is chairman of preventive medicine at Northwestern University Feinberg School of Medicine, in Chicago.
“When we look across the year in terms of heart attack rates, what we see is fairly constant rates week by week with two exceptions: One is that there’s a broad, shallow dip in summer months and, two, there is a very short spike of about 30% to 40% in the last couple weeks of the year between Christmas and New Year’s,” Lloyd-Jones said in a university news release.
It’s important not to underestimate symptoms, he stressed.
“We have two kidneys and two lungs, but only one heart and one brain, so it’s much safer to err on the side of caution,” Lloyd-Jones said. “If there’s any doubt, get checked out in person. At best, hopefully you are aborting a heart attack or stroke. Time is heart muscle, time is brain cells, and so time is of the essence. The sooner you seek help in that situation, the sooner we can save your life or brain.”
Family stress is an issue for some, as well as falling out of healthy habits.
“During the holiday season, there are different stresses like dealing with your in-laws and travel arrangements that may add stress,” Lloyd-Jones said. “We’re often knocked off our eating and sleeping patterns, we tend to consume more alcohol, we’re not pursuing our typical physical activity and we may get thrown off our medication schedule.”
Weather is another culprit when it comes to winter heart issues.
“When we breathe cold air, it chills the blood in our lungs and causes constriction of blood vessels,” Lloyd-Jones said. “The first blood vessels downstream from the lungs are the coronary arteries, which are particularly affected by the cold weather. Pursuing cold-weather activities, like shoveling, may be especially hazardous because we might overdo it, plus we’re wearing extra layers, which could cause us to overheat. It’s a perfect storm to maximize stress on the heart.”
Classic heart attack symptoms in men are heavy, crushing pressure in the middle of the chest, or sudden, unexplained shortness of breath.
Symptoms for women can be the same or more diffuse, such as experiencing just shortness of breath or profound fatigue, or occasionally, dizziness and lightheadedness.
Signs of stroke can be remembered through the memory aid, “FAST.” That stands for: Face drooping; Arm or leg weakness on one side; Speech difficulty; and Time to call 911.
Heart attack and stroke are the leading causes of death in the United States and around the world.
When Hannah Davis saw the first visual confirmation of long COVID in her blood – a firework-like display of fluorescent green dots against a black background – she was overwhelmed with an odd sense of relief. In early November, she became one of the first U.S. long COVID patients to be tested for microscopic blood clots, catching up to South Africa, Germany, the U.K., and other countries that are already experimenting with related treatments.
“It was validating,” says Davis, who excitedly shared the images of her clots on Twitter. “It’s basically the first test specific to long COVID that is promising and scientifically sound and incorporates research from other post-viral illnesses.”
Big news: I was lucky to get tested for micro blood clots, & I have a lot of them! #LongCovid
Healthy control blood on the left. Mine on the right. The green is all microclots!
These clots are likely blocking oxygen from getting around my body & could explain many symptoms. 1/ pic.twitter.com/5rtuzN8D8f— Hannah Davis (@ahandvanish) November 15, 2022
Davis donated her blood at Mount Sinai Hospital in New York City, with a few other founding members of the Patient-Led Research Collaborative, all of whom had been infected in the first wave of the pandemic and are still sick nearly 3 years later. Seeing the pictures of their blood clots, Davis and her fellow patients cried what she called happy tears. Then the reality of having those notorious blood clots sank in.
Early in the COVID-19 pandemic, emergency room doctors and others treating patients noticed the sickest produced excessive blood clots. The clots clogged kidney dialysis machines, caused strokes, and killed patients long after they left the hospital. Some long COVID researchers have suspected smaller, less obvious blood clots may be causing many of the puzzling symptoms reported by patients who have lasting effects of the virus.
The theory is that these weird and persistent clots, called microclots, might be blocking delicate blood vessels throughout the body, and stopping oxygen from getting to where it needs to go, causing everything from shortness of breath and organ damage to brain fog and debilitating fatigue. But if all the havoc is being done inside these minuscule clots, regular pathology tests won’t pick it up. A network of specialists is now setting out to see if specialized tests can be accessible and if the clots can be treated.
Clots Are Complicated
Blood clotting is an important and elaborate process that prevents excessive bleeding. Normally, the body will dissolve blood clots on its own, but in certain conditions, such as chronic fatigue syndrome (also known as myalgic encephalomyelitis or ME/CFS), diabetes, Alzheimer’s, Parkinson’s, and acute and long COVID, researchers have noticed that damage to the blood vessel walls caused by inflammation can lead to abnormal proteins and platelet activity. This leads to small, strange clots that can block capillaries – the smallest blood vessels – from taking enough oxygen to tissues throughout the body.
Net-like protein strands called fibrin are a critical part of clots. Viewed on an electron microscope, “they look like a bowl of spaghetti that you’ve just drained in a colander,” says Douglas Kell, PhD, a systems biologist at the University of Liverpool in the United Kingdom. The unusual “amyloid”-like version of the proteins seen in microclots, on the other hand, resemble “a disgusting mess that you sort of parboiled. It’s all stuck together,” Kell says.
Fluorescence microscopy of sample micrographs showing microclots (green) in the circulation of controls (A) and in patients with Long COVID (B–D).
These misfolded clots stain strongly with a special dye that glows bright green so they can be seen under a microscope, and they take longer to break down than normal clots through a natural process called fibrinolysis.
This problematic clotting may persist in blood for months or years after infection, according to research by Kell and physiologist Etheresia Pretorius, PhD, of Stellenbosch University in South Africa. Kell and Pretorius had studied unusual clotting for years before the pandemic. They also led the first team to discover these microclots in the blood of people with both acute and long COVID and have since authored a series of papers on the subject.
There are a number of theories as to what causes long COVID – from viral reservoirs and debris to overactive immune and antibody responses – but approaching the disease with a “systems biology mindset,” they actually feed into each other, says Pretorius.
Microclots in long COVID are being studied around the world by researchers and clinicians who refer to themselves as #TeamClots on Twitter, and who are hopeful that this theory represents a new and vital target in understanding and treating long COVID and related disorders. And they’re working to put this research into clinical practice.
In November, Pretorius traveled to the United States to train research teams on her identification techniques and help set up the equipment.
Still, why microclots happen after COVID-19 in the first place isn’t entirely understood. Pretorius and Kell believe that the spike protein in the virus might be the trigger in people with long COVID. That potential cause has been supported by a recent Harvard Medical School study that detected the SARS-CoV-2 spike antigen in most long COVID patients up to 12 months after diagnosis, suggesting the presence of an active and persistent viral reservoir in the body after infection.
“One core question is: Do these microclots actually represent a root cause, or are they in response to something else that’s ongoing?” says Michael VanElzakker, PhD, a neuroscientist and long COVID researcher at Massachusetts General Hospital and Harvard Medical School and co-founder of the PolyBio Research Foundation, which is focused on studying the viral reservoir. “If the clots are leftover residual from acute COVID, that would be one story. But if they’re forming in response to spike protein that’s leaking out from a reservoir … then that would be another story because you could clear the clots all day, but then they’ll just re-form.”
Treatment for Microclots
There are a number of early experimental treatments for these COVID-related microclots that still need to be tested in clinical trials.
Among them, a small but promising preprint study from Pretorius and Kell shows that a combination of antiplatelet and anticoagulant drugs for those with microclots improved long COVID symptoms and reduced microclots.
Meanwhile, researchers in Germany are reporting some success after an expensive and controversial dialysis-like treatment called heparin-induced extracorporeal LDL precipitation, or HELP apheresis, which has been performed on thousands of patients.
There is also considerable interest in far more accessible over-the-counter enzyme supplements that Pretorius and Kell will be studying in a lab environment next year. These include serrapeptase, lumbrokinase, and nattokinase (made from bacteria in silkworm gut, from earthworms, and from a bacterial fermentation of soybeans, respectively) that work as natural clot busters.
These supplements have long been available at health food stores, and long COVID patients are self-reporting their effects.
Most long COVID experts and hematologists advise against taking unproven supplements, anticoagulants, or blood-thinning treatments because of the obvious risks of excessive and even fatal bleeding. But they certainly understand why patients would feel the desperate need for them.
“I can’t imagine being in a situation where you’re just supposed to sit around and wait for genius researchers to solve it,” says VanElzakker. “The way that it played out with AIDS, is that a lot of the information about the things tested came from the patients.”
Davis is also worried about patients recommending unproven treatments to each other, as individuals could react poorly.
In the meantime, Davis, Pretorius, and other long COVID advocates and researchers who believe that microclots are the best explanation for the condition say the next steps should be made urgently: Make the tests accessible, fund more studies, and start clinical trials.
Relying on routine lab tests that show long COVID patients are perfectly healthy when they obviously are not is no longer acceptable, not just for the patients, but for researchers seeking solutions. “These individuals are really, really sick,” says Pretorius. “So just because Western medicine hasn’t found the biomarker that the regular pathology laboratory can easily test doesn’t mean it doesn’t exist.”
Keeping off weight during the holiday season can be tough. But there are many reasons to maintain a healthy weight all year round. A healthy weight lowers your risk for chronic diseases, like diabetes, heart disease, and certain cancers. It can also help you stay more mobile as you age.
Excess weight comes from taking in more energy, or calories, than your body needs. Some extra energy may be stored as fat. Many factors influence your risk for weight gain. These include poor diet, lack of sleep, and not getting enough physical activity. Genes can also play a role. Certain medications affect weight gain, too.
“In the U.S., we all live in an obesity-promoting environment to some degree,” says Dr. Susan Yanovski, an NIH expert on obesity and eating disorders. “We are constantly tempted with low-cost, high-calorie foods. And, we’re expending a lot less energy than we used to in everyday life. Many jobs are sedentary, and even household activities like washing dishes take less energy to do now. You throw them in the dishwasher. We have to work hard to incorporate activity into our everyday life.”
Taking steps toward a healthy lifestyle—even small ones—can help you get on a path to a healthy weight.
Calculating a Healthy Weight
The definitions of overweight and obesity are based on body mass index, or BMI. BMI is based on your height and weight. Overweight for adults is a BMI between 25 and 29.9. Obesity is a BMI of 30 or greater. NIH has a tool to help you calculate your BMI.
“BMI is quick and easy to obtain, but it’s not perfect,” Yanovski says. A high BMI is usually caused by extra body fat. But it can also come from extra muscle, bone, or water.
If your BMI is high because of extra body fat, aim to lose about one to two pounds per week. “Some people might think losing weight quickly is the best strategy,” says Dr. Alison Brown, a nutrition scientist at NIH. “But really, the safer and more sustainable weight loss is gradual.”
To lose weight, you need to burn more calories than you take in. “Combining both calorie restriction plus physical activity tends to be most effective for weight loss,” Brown says.
Cutting Down Calories
To lose weight, experts suggest taking in about 500 fewer calories than you burn per day. This should get you to about one pound per week of weight loss, Yanovski says.
The NIH Body Weight Planner can help you calculate exactly how many calories you need for your weight loss goals. The tool takes your age, sex, and level of physical activity into account.
Experts recommend limiting less healthy foods that are high in calories, saturated and trans fats, refined carbohydrates, or sugar. “But there’s not one recommended diet for weight loss,” Yanovski says.
“The best diet is the one that you can stick with,” explains Brown. “It should be balanced and provide a variety of fruits and vegetables, whole grains, lean meats, and low-fat dairy or dairy alternatives.” For more about a healthy diet, see the Dietary Guidelines for Americans (HHS)(link is external).
Creating an eating plan based on your likes and dislikes can help you stick with it. You can use nutrition labels to estimate how many calories a food has. But be sure to check the serving sizes. Learn more about nutrition labels (FDA)(link is external).
“It is easier than it’s ever been to try to figure out what you’re actually taking in with all the trackers and food labeling,” says Yanovski. “But, of course, you have to be honest with yourself.”
A registered dietitian or a weight management program can also help you create a healthy eating plan.
Getting More Activity
Physical activity helps you burn off the calories you consume. Studies have found that it’s critical for maintaining a stable weight.
Experts recommend that adults get at least 150 minutes of moderate-intensity aerobic activity each week. Aerobic activity is anything that gets your heart rate up and gets you breathing harder. Examples of moderate-intensity activities include brisk walking (faster than 2.5 miles per hour), swimming, and dancing.
If you’re able, start increasing your physical activity. Doing so slowly can help prevent injuries. Even light activity burns more calories than being sedentary. Start small. Take the stairs instead of the elevator. Break up your day with short walks.
You can also break up moderate-intensity activity into short sessions. Every minute counts toward your weekly goal!
Don’t forget to do muscle-strengthening activities, like lifting weights. Experts recommend adults do them at least two days a week.
Staying on Track
Creating new habits can help you lose and maintain your weight. Weigh yourself regularly to see if you’re meeting your weekly goals. You can use an app or journal to track your physical activity and food intake. Some devices can automatically track and record your activity. Calculate whether you’re burning more calories than you’re taking in.
Getting social support can help keep you motivated. Apps and social media sites may connect you with other people who support your goals.
“But often, people differ in terms of what they consider supportive,” notes Dr. Laurie Friedman Donze, a clinical psychologist at NIH. “So it’s important to communicate with your support system and let them know what you feel is helpful or unhelpful.”
“Trying to keep your stress under control and getting enough sleep are also good for preventing weight gain,” says Donze. “Stress can affect food cravings. Often, people will eat to reduce stress or as a way to comfort themselves. Not getting enough sleep may also increase your appetite or cravings for high-fat foods.”
“No matter what your weight loss goal is,” says Brown, “it takes time. Be patient with the process.”
It can be difficult to lose or keep weight off. Some people may benefit from medication or surgery in addition to lifestyle changes. If you’re struggling with losing weight or maintaining weight loss, ask your health care provider if medications or surgery may be helpful for you.
“An NIH study, called POWERS, is studying why some people struggle over time to maintain weight loss and why some are going to find it easier,” says Yanovski. “We hope to come up with better strategies for people who struggle with obesity and to individualize solutions for keeping lost weight off.”
Sulfonylureas (SUs) are one of the commonly prescribed oral anti-hyperglycemic agents (AHA) in low- and middle-income countries (LMICs), either in combination with metformin therapy or alone. However, concern about cardiovascular safety has limited the use of SUs in the management of type 2 diabetes mellitus (T2DM). Additionally, lack of uniformity in the national and international guidelines regarding the positioning of SUs in the management of diabetes has also been reported. The objective of this review was to assess the various national and international guidelines on diabetes management and understand the recommendations specific to SUs in various scenarios. A total of 33 national and international guidelines on the management of T2DM published in English were evaluated. These guidelines have considered the latest evidence and suggest the use of certain second-generation SUs as second-line therapy or in combination with other AHAs in select population and specific scenarios. Identification of the appropriate population, classification based on underlying risk, thorough assessment of the comorbid conditions, and a step-wise approach for the selection of appropriate SUs is essential for the effective management of T2DM. Additionally, cost-to–benefit ratio should be considered, particularly in LMICs, and SUs could continue to play an important role in such settings.
Conclusion
Sulfonylureas continue to play a vital role in the management of T2DM. Majority of the international and national guidelines reviewed in this article suggest newer SUs as second-line therapy for treatment of people with T2DM. The newer SUs, such as glimepiride and gliclazide MR, are efficacious, comparatively less expensive and are associated with low rates of hypoglycemia, weight gain, and cardiovascular toxicity compared to the conventional SUs. Hence, despite the continuous advent of newer glucose-lowering therapies, SUs may still be an ideal pharmacological treatment choice in developing countries.
Sulfonylureas are commonly prescribed oral anti-hyperglycaemic agents for the management of diabetes.
According to the International Diabetes Federation (IDF) guidelines:
Sulfonylureas (except Glibenclamide/Glyburide) are recommended for patients who are not tolerant to Metformin.
Sulfonylureas (except Glibenclamide/Glyburide), Sodium–glucose co-transporter-2 inhibitors (SGLT2is), or Dipeptidyl peptidase 4 (DPP-4) inhibitors can be prescribed in combination with Metformin.
It is advised to educate patients regarding the prevention, recognition, and management of hypoglycaemia while initiating sulfonylureas.
As per the recommendations of the World Health Organisation (WHO):
When Metformin monotherapy fails to attain glycaemic control, or for patients with Metformin intolerance, sulfonylureas are recommended.
The usage of modern sulfonylureas, such as Gliclazide, is advised to ensure better safety.
According to the European Association for the Study of Diabetes (EASD) recommendations:
Compared to lifestyle interventions alone, the addition of sulfonylureas effectively mitigates the cardiovascular risk. Therefore, it is recommended in patients with type 2 diabetes mellitus (T2DM).
Relatively lesser adverse events, such as hypoglycaemia and cardiovascular toxicity, are associated with the use of newer sulfonylureas, such as Glimepiride.
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