Diabetes medications shown to lower risk of cardiovascular disease

Diabetes medications shown to lower risk of cardiovascular disease

Parkland expert says ‘benefits to patients undeniable’

If you have diabetes, you are twice as likely to die from heart disease, heart failure, heart attack or stroke than someone without the disease. This threat is in addition to the other significant health problems caused by diabetes. But in the past few years, diabetes patients got some good news. Studies testing the safety of certain diabetes drugs used to lower glucose, or blood sugar, found that they also help lower the risk of having a heart attack, stroke or dying from such an event.

“This is tremendous news that still has barely reached the public and the primary care environment, despite the potential impact on reducing mortality and disease burden. The potential benefits to patients are undeniable,” said Luigi Meneghini, MD, endocrinologist and Executive Director of the Global Diabetes Program at Parkland, and Professor of Internal Medicine at UT Southwestern Medical Center.

February is American Heart Month, a time when health experts want to raise awareness that heart disease is the leading cause of death for both men and women in the U.S. Every 80 seconds in American an adult with diabetes is hospitalized for heart disease and every two minutes an adult with diabetes is hospitalized for stroke, Dr. Meneghini noted.

Parkland cardiology nurse Teresa Prestidge, RN, 63, who was diagnosed with congenital heart defects at birth and with diabetes 15 years ago, was hospitalized in May 2017 after she collapsed with “an A1C number and heart a-fib that were off the charts,” she said. “How I lived I have no idea.”

Prestidge, who had lost 110 pounds following her diagnosis with type 2 diabetes and felt “on top of the world” until that fateful weekend, landed in Parkland’s medical intensive care unit.

Although she had taken heart medications her entire life due to her atrial septal defect and was taking insulin and metformin for diabetes, Dr. Meneghini strongly recommended that Prestidge add another diabetes medication, empagliflozin for its cardio-protective properties.

“The most common cause of death for adults with diabetes is heart attack or stroke. The discovery that these diabetes drugs can reduce the risk of a cardiovascular event, especially in those patients at the highest risk, will have a significant impact on public health and on the quality of life and longevity of millions of people like Teresa,” Dr. Meneghini said.

Two classes of type 2 diabetes medications approved by the Food and Drug Administration (FDA) to treat diabetes now have official indication to reduce the risk of cardiovascular death (or major adverse cardiovascular events) in adults with type 2 diabetes and established cardiovascular disease. The first are empagliflozin and canagliflozin, part of a class of drugs called sodium-glucose co-transporter-2 (SGLT2) inhibitors that lower blood sugar by helping the body excrete it in urine and also prevent excess fluid from building up in the body, which reduces the risk of heart failure.

The other diabetes medication approved for treating heart disease is liraglutide, an injectable drug in the glucagon-like peptide 1 receptor agonists (GLP-1 RA) class. This drug helps regulate insulin to keep blood sugar levels normal and was shown in clinical trials to reduce the risk of major adverse cardiovascular events which include heart attacks, strokes or dying from either.

Cardiovascular outcome trials of diabetes medications began in 2008 when the FDA required glucose-lowering diabetes drugs to be tested to prove they were not negatively impacting heart health. Results from these studies over the past 10 years showed that some of the drugs actually improved cardiovascular outcomes, an unexpected but welcome surprise.

“This was very exciting news that resulted in new clinical guidelines by the American Diabetes Association for the management of type 2 diabetes,” said Dr. Meneghini. “If you are a patient who has type 2 diabetes and have suffered from a complication such as a heart attack, stroke, kidney damage, poor circulation, heart failure, or are at high risk for these complications, you need to talk to your doctor about the option of adding one of these therapies to your diabetes prescription regimen.”

According to the American Diabetes Association (ADA), the disease affects 11.8 percent of Americans. More than 30 million adults have diabetes and an estimated 85 million Americans have prediabetes, a condition in which blood sugar levels are not high enough to be classified as diabetes, but are elevated above normal levels. Persons with prediabetes have a 50 percent chance of developing type 2 diabetes if they don’t make significant lifestyle changes, such as diet and physical activity. The ADA estimated that total annual cost of diagnosed diabetes in the U.S. in 2017 was more than $327 billion.

More than 39,000 patients with diabetes are cared for at Parkland. It’s estimated that 37 percent of Texans have prediabetes and more than 660,000 Texans have diabetes but are undiagnosed.

“I didn’t want to take another medication but I am so grateful that Dr. Meneghini convinced me to. I trust him. I work with heart patients at Parkland every day and they are really special to me,” Prestidge said. “I don’t consider myself sick even though I have a bad heart. With the help of medications and good medical care, people like me can live long and healthy lives.”

For more information about diabetes, go to www.parklanddiabetes.com. For more information about Parkland, please visit www.parklandhospital.com