Diabetes drugs may help reduce risk of cardiovascular events in older adults

Researchers tested three major types of diabetes medications

ISLAMABAD, (Online) - Some diabetes medications could decrease the risk of cardiovascular events when added to other diabetes medications, according to a study published today in the Annals of Internal Medicine.

Researchers tested three major types of diabetes medications – GLP1, DPP4, and SGLT2 – to existing diabetes treatment regimens.

The scientists noted that recent clinical trials for newer diabetes medications:

• Tested the drugs vs. a placebo but did not test the drugs against one another

• Looked at cardiovascular benefits but only by testing in people who already had heart disease

The researchers wanted to know which class of medications was best for reducing the risk of cardiovascular disease, even in people who did not previously have heart disease.

They reported that the GLP1 drugs reduced the risk of adverse cardiovascular events and heart failure hospitalizations compared to DPP4 medications.

SGLT2 drugs did not reduce cardiovascular events or heart failure hospitalizations compared to DPP4 medications. The median age of participants was 67 and the median duration of diabetes was 8.5 years.

The findings included:

• GLP1 reception agonists were associated with about a 20% reduced risk of major adverse cardiovascular events and heart failure hospitalizations compared to DPP4 inhibitors in people with type 2 diabetes and no prior heart disease. The reduced risk is about three fewer heart failure events, strokes, or deaths in 1,000 people using the medication for one year.

• SGLT2 inhibitors did not reduce cardiovascular events and heart failure hospitalizations compared to DPP4 inhibitors.

“According to the [American Diabetes Association] guidelines, therapies should emphasize efficacy in achieving and maintaining treatment goals for glucose and weight management,” said Dr. Kathleen Dungan, an endocrinologist at The Ohio State University Wexner Medical Center.

“As such, some GLP1-based therapies have greater potential to help patients achieve these goals compared to SGLT2i or DPP-4 inhibitors,” she told Medical News Today. “However, other person-centered factors such as other co-occurring conditions, patient preference, complexity and route of administration, side effects, and cost may be more important.”

“Some limitations [of this study] preclude our ability to apply the findings directly to usual care,” Dungan said. “These include short duration of follow-up, lack of diversity in demographics, incomplete/missing data, and nonrandom prescribing patterns, any of which could influence the study findings.”

“These medications were initially designed to lower glucose. However, the [Food and Drug Administration] requires that drugs used to treat glucose prove their cardiovascular safety. Because of this, they are easily evaluated for cardiovascular health risk improvement,” said Dr, Jonathan Newman, an assistant professor of cardiology in the Department of Medicine at NYU Grossman School of Medicine and a cardiologist at NYU Langone Heart in New York.

“This study provides important information on using two classes of diabetes medication, especially for people without known cardiovascular disease,” he told Medical News Today.

The importance of the diabetes drugs study

Heart disease is twice as likely to occur in people with diabetes and at a younger age. The longer you have diabetes, the more likely you are to have heart disease, according to the Centers for Disease Control and Prevention.

People with diabetes are also more likely to have high blood pressure and high levels of “bad” cholesterol and triglycerides. These conditions can increase your risk of having a cardiovascular event.

“This study is an excellent example of the new convergence of therapeutics for diabetes and cardiovascular diseases,” said Dr. Sanjay Bhojraj, an interventional cardiologist at Providence Mission Hospital in California. “In the past, the cardiology community has primarily avoided optimizing diabetic medications either out of fear of alienating other treating physicians or concerns over medication-related complications. Primary prevention studies such as this are a call to action for cardiologists to finally jump into the ring and treat diabetes like we treat cholesterol or address smoking cessation.”

“Now we have real-world data, in a [veterans] population, suggesting a significant decrease in major adverse cardiovascular events using GLP-1 receptor antagonists in patients who have diabetes without prior [cardiovascular disease],” Bhojraj told Medical News Today. “This may inform the clinician’s decision as to which class of diabetes medicine should be added on top of standard-of-care treatment plans to optimize cardiovascular risk. Interestingly, in the aggregate population of primary and secondary prevention patients, treatment effects were seen for both the GLP-1 and SGLT-2 drug classes.”

“Bottom line,” Bhojraj added, “the cardiology community must step up and add glycemic optimization to our treatment plans if we really want to protect our patients from major adverse cardiovascular events.”

Treating coexisting conditions common with diabetes

A 2019 study revealed that almost 75% of people had at least one other chronic health condition at the time they were diagnosed with type 2 diabetes. Around 44% have at least two conditions.

Some common coexisting conditions with diabetes include:

• obesity

• dyslipidemia

• high blood pressure

• heart disease

• kidney disease

• mental health disorders

• sleep disorders

• cancer

“Generally speaking, in patients with diabetes and obesity – two conditions which overlap more than often than not – a GLP1 RA is preferred over an SGLT-2 for the weight benefit,” said Dr, Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York.

“But this study also highlights another benefit to choosing a GLP1 over an SGLT-2 in patients without cardiovascular disease,” she told Medical News Today.

Obesity is not the only coexisting condition these drugs help, experts note.

“This research is encouraging and supports a growing body of evidence that these medications have multiple beneficial effects,” said Dr, Rigved Tadwalkar, a cardiologist at Providence Saint John’s Health Center in California.

“In the case of GLP-1 receptor agonists, the medications are currently being used off-label to treat obesity. SGLT2 inhibitors are additionally approved for treating chronic kidney disease and heart failure,” he told Medical News Today.