Survey Highlights Challenges With Managing CV Risks in Patients With Diabetes
It's no secret that patients with diabetes are at increased risk of heart disease, heart failure and stroke. Additionally, diabetes can lead to high blood pressure and increased cholesterol. Managing these increased cardiovascular risks in patients with diabetes is fast becoming a topic of discussion in the cardiology space.
A recent ACC CardioSurve survey found that more than four out of five cardiologists (81 percent) agree that cardiologists should play a larger role in addressing cardiovascular risks in their patients with diabetes. This perception was strongest among general cardiologists than those in more specialized areas of cardiology, like interventional cardiology or electrophysiology. The challenge lies in how to go about doing this.
Several important randomized trials (i.e., EMPA-REG, SUSTAIN-6 and LEADER) show medical interventions in cardiovascular patients with diabetes can provide protective benefits. However, results from the CardioSurve survey suggest more needs to be done to raise awareness of these trials and their outcomes. Specifically, nearly 70 percent of survey respondents said they were not familiar with these trials. Of those who were aware, about one out of four (25 percent) were familiar with the EMPA-REG results, 21 percent were familiar with LEADER, and only 14 percent were familiar with SUSTAIN-6.
Similarly, knowledge of these trials alone has been slow to bring about practice change. Only about one out of five cardiologists familiar with any of these trials said they have changed how they treat their patients. The most common change was more active recommendations to patients and/or their primary care physicians or endocrinologists about these new drugs and their potential to lower cardiovascular risks. “I include a recommendation in the letter to the referring primary care physician that there may be a survival advantage to the use of newer agents in the treatment of patients with CAD and T2D,” said one survey respondent. “Despite cost concerns they may wish to prescribe alternate or additional medication.”
“With the new data, we all need to get up to speed,” says Christopher P. Cannon, MD, FACC, in a recent ACC.org video talking about the recent trials and their potential benefits. “As cardiologists we feel that we want to provide that cardiovascular protection. But how do we do that? We haven’t managed diabetes.” He stresses the importance of creating more dialogue between primary care, endocrinologists and cardiologists, noting that the cardiovascular profession has undertaken similar dialogue and partnerships around the use of dual antiplatelet therapy and cholesterol therapy. “There’s room for a really good partnership,” he says.
In his recent “Eagle’s Eye View” podcast, Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org, discusses the cardiovascular effects of the SGLT-2 class of drugs, illustrating “that as we get into a whole new world in terms of managing diabetes and cardiometabolic disease, especially as these drugs affect cardiovascular outcomes, cardiovascular specialists are going to have to be more and more comfortable both prescribing them and following patients with them.”
World Health Organization statistics show the global prevalence of diabetes among adults has risen from 4.7 percent in 1980 to 8.5 percent in 2014. Worldwide, the number of people with diabetes has risen from 108 million to 422 million during this same period. Whether it’s developing patient education resources, leveraging data from the Diabetes Collaborative Registry to identify and capture key learnings and best practices from cardiovascular innovators, or holding its first “Managing CV Disease Risk in Diabetes Roundtable,” the College is focused on helping its members to best manage the cardiovascular risks associated with this increasing number of people with diabetes. The roundtable, which will take place in June, is designed to address the recent trial evidence for new antidiabetic drugs, their demonstrated improved cardiovascular outcomes and what that means for the cardiology community. Participants will address the key questions facing clinicians and work towards identifying solutions to overcome the gaps in knowledge and barriers to care.
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