Glycemic control key factor in reducing CV risk

George L. Bakris

PHILADELPHIA — Solid evidence exists that improved glycemic control reduces microvascular complications in people with diabetes, according to a speaker at the Heart in Diabetes Conference.

Drugs used in patients with diabetes to improve glycemic control may have independent effects on numerous pathways related or unrelated to cardiovascular risk in diabetes, and studies have shown that glycemic control also extends to benefit CV outcomes, George L. Bakris, MD, FASN, FASH, professor of medicine and director of the American Society for Hypertension Comprehensive Hypertension Center, University of Chicago Medicine, said during a keynote presentation.

According to Bakris, other studies have shown that intensive therapy and lifestyle interventions can decrease the risk for a composite CV endpoint of death and major macrovascular and microvascular events. However, one challenge is ensuring that patients are adhering to such interventions, he said.

Moreover, “newer trials in diabetes show that agents associated with weight loss and blood pressure lowering, without hypoglycemia, yield CV risk reduction, particularly with volume dependent CV endpoints like heart failure,” Bakris said.

With regard to the effect of diabetes medications on renal outcomes, Bakris noted that the results of four studies examining renal outcomes in patients with diabetic kidney disease and secondary CV events are expected to be released beginning later this year. These trials include the EMPA-REG nondiabetic kidney disease outcome trial; the Selective Endothelin-1 Receptor Blocker (SONAR) trial; the CREDENCE trial, examining the use of canagliflozin (Invokana, Invokamet; Janssen); and the FIDELIO-DKD trial, examining the use of finerenone (Bayer).

Looking ahead, “within the next 3 years, there is going to be a tremendous amount of information coming out not only about renal outcomes in diabetes but also about the use of agents complementing other BP-lowering or glucose-lowering agents to see what the benefit is going to be on outcomes,” Bakris said.

However, Bakris said, historically, no glucose-lowering regimen has definitively demonstrated reduced macrovascular complications, including myocardial infarction, stroke and angina.

“Several agents actually worsen cardiovascular outcomes, and a lot of them are still use,” Bakris said. “We have to be very careful when looking at clinical trials, they don’t represent everyone. We have to keep in mind that hypoglycemia is a major confounder in many of these trials that affect the results.” – by Amber Cox

Reference:

Bakris GL. CV Outcomes and Safety of Oral Glucose Lowering Agents: Implications for Clinical Practice. Presented at: Heart in Diabetes Medical Conference; July 14-16, 2017; Philadelphia.

Disclosure: Endocrine Today was unable to confirm relevant financial disclosures.