New Tools Help Reduce CVD Risk in Veterans with Diabetes

By Annette M. Boyle

The search has been on for decades: A medication that can help reduce the risk of cardiovascular disease in Type 2 diabetes patients. Late last year, an existing drug was approved by the FDA for that additional a usage, potentially benefiting the more than million veterans with high blood sugar.

PHOENIX—Finding a way to substantially reduce the risk of cardiovascular disease (CVD) in Type 2 diabetes mellitus (T2DM) has been a nearly mythic quest for endocrinologists.

Patients with diabetes have a substantially increased risk of myocardial infarction, stroke and CVD-related mortality that controlling serum glucose alone does not appear to eliminate. Recent studies, however, indicate that an existing antidiabetic agent, empagliflozin, may help diabetics reduce both glycated hemoglobin levels and cardiovascular disease risk.

Veterans attended “diabetes camp” at Camp American Legion in Lake Tomahawk, WI, last September to learn how to better manage their diabetes and avoid complications such as cardiovascular disease. VA photo

That could be good news for the 1 in 4 veterans with a diagnosis of diabetes.

Last winter, the U.S. Food and Drug Administration added an indication for the sodium-glucose co-transporter 2 (SGLT2) inhibitor. “Empagliflozin is now approved for use to treat blood glucose in type 2 diabetes as well as to reduce CVD in patients with T2DM. The agent, therefore, can be effective in two very important areas of concern for our patients with T2DM,” said Peter Reaven, MD, director of the Diabetes Research Program at the Phoenix VA Health Care System.

By blocking the SGLT2 protein that drives glucose reabsorption in the kidneys, SGLT2 inhibitors increase glucose excretion in urine and lower glucose levels in the blood. They also have a slight diuretic effect, which appears to reduce blood pressure, without increasing heart rate.

“Although there are now a wide variety of effective glucose lowering agents for diabetes, the SGLT2 inhibitor class of medications offers some unique advantages that complement other diabetes medications, making it a valuable add-on medication,” Reaven told U.S. Medicine.

The Empagliflozin, Cardiovascular Outcomes and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial found that empagliflozin reduced the risk of death from cardiovascular disease 38% and all-cause death by 32%. The risk of hospitalization for heart failure dropped 35%, while the risk of transient ischemic attack declined 15% and the rate of stroke rose 18%.1

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