Cardiovascular Importance of New Diabetes Drugs

Sattar N, Petrie MC, Zinman B, Januzzi JL Jr.
Novel Diabetes Drugs and the Cardiovascular Specialist. J Am Coll Cardiol 2017;69:2646-2656.

The following are key points to remember from this review on novel diabetes drugs and the cardiovascular (CV) specialist:

  1. In light of concerns regarding CV safety of new glucose-lowering drugs being developed, the United States (US) Food and Drug Administration (FDA) and European Medicines Agency had mandated that new therapies for diabetes must demonstrate CV safety in prospective, randomized, controlled outcome trials.
  2. On the basis of outcome studies, sulfonylurea medications carry a “black box” CV warning from the FDA regarding heightened risk for CV events, although the same is not true in many non-US countries.
  3. It should be noted that up until recent trials reported, metformin was the only drug with possible evidence for CV benefit.
  4. Importantly, metformin does not cause weight gain or increased risk for hypoglycemia, has many years of safety evidence, is inexpensive, and is appropriately widely used as a first-line therapy for diabetic patients with CV disease.
  5. Recent studies have reported that treatment with newer classes of type 2 diabetes drugs reduce events in patients with diabetes and cardiovascular (CV) disease, a group common in cardiology clinics.
  6. The sodium-glucose cotransporter (SGLT) 2 inhibitor, empagliflozin, markedly and rapidly reduced CV death and heart failure hospitalization, likely with hemodynamic/metabolic-driven mechanisms of action.
  7. The glucagon-like peptide (GLP)-1 receptor agonists liraglutide and semaglutide also reduced CV death and major adverse CV events, but did so more slowly and did not influence heart failure risks, suggesting alternative mechanisms of benefit.
  8. Cardiologists should familiarize themselves with diabetes drug classes with CV benefits, as many of their patients (i.e., type 2 diabetes plus CV disease) could benefit from their use.
  9. Cardiologists should also consider screening more widely for T2D, to identify patients who could benefit sooner from such drugs.
  10. In analogy to the “heart team” approach used for those with other forms of heart disease, collaboration between cardiologists, primary care physicians, and diabetologists will be necessary to achieve the goal of more optimal treatment of vulnerable patients with type 2 diabetes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glucagon-Like Peptides, Glucose, Heart Failure, Hemodynamics, Hypoglycemia, Hypoglycemic Agents, Metabolic Syndrome X, Metformin, Outcome Assessment (Health Care), Pharmaceutical Preparations, Primary Prevention, Sulfonylurea Compounds, Weight Gain

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