Managing CV Risk in Patients With Type 2 Diabetes

Cardiologists are treating more and more patients with established cardiovascular disease and diabetes. Diabetes, particularly type 2 diabetes, is common in patients with an array of cardiovascular disorders including coronary artery disease, peripheral vascular disease, congestive heart failure and stroke. Over the last decade, studies have shown that patients with diabetes are at greater risk of dying from these cardiovascular diseases than those without diabetes.

“We know that few patients with [type 2 diabetes], even in the U.S., despite its sophisticated health care systems, attain guideline-directed goals for the conventional cardiovascular risk factors including lipids, blood pressure, blood glucose and weight, and when inadequately controlled, lead to significant residual risk for cardiovascular complications,” said Norman Lepor, MD, FACC, in a recent article in Cardiology.

Several important randomized trials show medical interventions in cardiovascular patients with diabetes can provide protective benefits. In the EMPA-REG OUTCOME trial, empagliflozin reduced the incidence of the composite endpoint of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke by 14 percent, while death from cardiovascular-related causes was reduced by 38 percent. Heart failure was also reduced by 35 percent. In the SUSTAIN-6 trial evaluating semaglutide, death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, was reduced by 26 percent compared with patients on placebo. Nonfatal stroke was reduced by 39 percent. Results from the LEADER trial showed liraglutide reduced death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke by 13 percent. Death from cardiovascular causes was reduced by 22 percent.

Expo"We know that few patients with [type 2 diabetes], attain guideline-directed goals for the conventional cardiovascular risk factors including lipids, blood pressure, blood glucose and weight. " Norman Lepor, MD, FACC

Deciphering the findings from these trials was a key component of a session chaired yesterday by Christopher Cannon, MD, FACC. The session also offered a closer look at the new therapies and included robust discussion and debate on the cardiologist’s role in managing cardiovascular risk in their diabetic patients.

According to Nathan D. Wong, PhD, FACC, it is critical going forward that cardiologists not only employ a team-based approach in collaborating with endocrinologists and other providers managing patients with diabetes, but also to understand the cardioprotective effects of the newer diabetes therapies that could take a leading role in reducing cardiovascular risk in their diabetic patients.

To help in the effort to better combine forces between cardiologists and diabetologists, the ACC, in partnership with the American Diabetes Association, American College of Physicians, American Association of Clinical Endocrinologists, and Joslin Diabetes Center, created the first worldwide Diabetes Collaborative Registry.

The College, with support from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly and Company, is also working to raise awareness and prepare the cardiology community for the coming paradigm shift. Leveraging data from the Diabetes Collaborative Registry, the College will identify and capture key learnings from cardiovascular innovators who are managing cardiovascular risk reduction for people with type 2 diabetes. These learnings will be communicated to the wider cardiology community and used to help develop clinician and patient tools.

“The ACC believes the efforts to educate and communicate about innovative advances in cardiovascular risk reduction in type 2 diabetes is the first stage in a longer-term process of optimizing cardiovascular risk reduction in complex patient populations, thereby continuing recent reductions in the overall morbidity and mortality of cardiovascular disease,” says Wong.

“Along with [Eli] Lilly, Boehringer Ingelheim is proud to support the ACC in its efforts to drive quality improvement in cardiology,” said Thomas Seck, MD, vice president of Clinical Development and Medical Affairs – Primary Care, Boehringer Ingelheim Pharmaceuticals, Inc. “Given recent advances in research on cardiovascular risk reduction for people with type 2 diabetes, we need a better understanding of how and when innovative health care professionals are adopting new tools in our efforts to help educate the wider cardiology community.”

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Clinical Topics: Heart Failure and Cardiomyopathies, Vascular Medicine, Acute Heart Failure

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Annual Scientific Session, Benzhydryl Compounds, Blood Glucose, Coronary Artery Disease, Diabetes Mellitus, Type 2, Glucosides, Heart Failure, Myocardial Infarction, Peripheral Vascular Diseases, Primary Health Care, Quality Improvement, Registries, Registries, Risk Factors


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