The Changing Landscape of Diabetes Therapy for Cardiovascular Risk Reduction

Newman, Jonathan; Vani, Anish; Alemán, José O.; Weintraub, Howard; Berger, Jeffrey S.; Schwartzbard, Arthur

doi:10.1016/j.jacc.2018.07.071

Cited by 76 publications

(42 citation statements)

References 87 publications

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“…Meanwhile, the mechanisms by which the two drug classes exert cardiac protective effects are summarized in two recent review articles [ 24 , 25 ]. Among all mechanisms mentioned in the two articles [ 24 , 25 ], an important mechanism is that the two drug classes are able to reduce cardiac afterload [ 26 , 27 ] and preload [ 28 – 30 ] by various means.…”

Section: Discussionmentioning

confidence: 99%

GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression

et al. 2020

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Introduction: The impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events during the treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) for type 2 diabetes is unclear. Methods: We searched Embase and PubMed. We performed meta-analysis using hazard ratio (HR) and 95% confidence interval (CI) as effect size stratified by drug class on six endpoints of interest, which were major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), cardiovascular death (CVD), myocardial infarction (MI), stroke, and all-cause death (ACD). We performed meta-regression to assess the difference between GLP-1RAs and SGLT2is, and the impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events. Results: We included 11 randomized trials. Compared with placebo, SGLT2is reduced HHF by 32% (HR 0.68, 95% CI 0.60-0.76) whereas GLP-1RAs reduced HHF by only 9% (HR 0.91, 95% CI 0.83-0.99). The benefit from SGLT2is on HHF was significantly greater than that from GLP-1RAs (P subgroup = 0.004). GLP-1RAs reduced stroke by 16% (HR 0.84, 95% CI 0.76-0.93) whereas SGLT2is did not reduce stroke (HR 0.96, 95% CI 0.82-1.12). GLP-1RAs and SGLT2is Digital Features To view digital features for this article go to

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Section: Discussionmentioning

confidence: 99%

GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression

et al. 2020

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“…29 Increasingly, as novel diabetes drugs continue to improve cardiovascular outcomes, we expect the positive reductions in CVD mortality among individuals with diabetes to continue. 30 DM is a multisystem disease and, as DM-related vascular complications continue to decline, a rise in other causes of death is expected. For example, we found that those with DM on their death record as three times as likely to have hypertension and renal disease co-reported on their death records.…”

Section: Discussionmentioning

confidence: 99%

Diabetes-attributable mortality in the United States from 2003 to 2016 using a multiple-cause-of-death approach

Rodríguez

Blum

Falasinnu³

et al. 2019

Diabetes Research and Clinical Practice

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Aims: Deaths attributable to diabetes may be underestimated using an underlying cause of death (COD) approach in U.S. death records. This study sought to characterize the burden of diabetes deaths using a multiple-cause of death approach and to identify temporal changes in co-reported causes of death among those with diabetes listed anywhere on their death records. Methods: COD were identified using data from the National Center for Health Statistics from 2003-2016. We calculated age-adjusted mortality rates for diabetes as the underlying or contributing COD by race/ethnicity. We used ICD-10 codes to identify leading causes of death among those with and without diabetes on their death records. We compared temporal changes in deaths due to cardiovascular disease, cerebrovascular disease, cancer, and other causes.

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“…Although overall control of major CV risk factors has greatly improved over the last 10 years, 34,35 the rates of CV events are still higher in adults with T2D than in the non‐diabetic population 36 . Up to now, enforcing tight glycaemic control has failed to convincingly show a clear benefit on macrovascular complications, 34 whereas the benefits of optimal glucose control on microvascular outcomes have been shown in several large trials 28,37–39 …”

Section: The Changing Scenariomentioning

confidence: 99%

Positioning sulphonylureas in a modern treatment algorithm for patients with type 2 diabetes: Expert opinion from a European consensus panel

Consoli

Czupryniak

Duarte

et al. 2020

Diabetes Obesity Metabolism

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The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. Because newer agents offer several advantages, whether and when sulphonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The current consensus paper aims to provide additional guidance on the use of SUs in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second‐line treatment after metformin and are often ranked at the same level as newer glucose‐lowering medications. Strong evidence now shows that sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) are associated with low hypoglycaemia risk, promote weight loss, and exert a positive impact on vascular, cardiac and renal endpoints. Thus, using SUs in place of SGLT‐2is and GLP‐1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT‐2is and/or GLP‐1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second‐line agents continues to be acceptable in resource‐constrained settings.

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The Changing Landscape of Diabetes Therapy for Cardiovascular Risk Reduction

Cited by 76 publications

References 87 publications

GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression

GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression

Diabetes-attributable mortality in the United States from 2003 to 2016 using a multiple-cause-of-death approach

Positioning sulphonylureas in a modern treatment algorithm for patients with type 2 diabetes: Expert opinion from a European consensus panel

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