Cardiovascular disease (CVD) is the No. 1 killer of persons with diabetes. Although lowering blood glucose improves microvascular complications, the relationship between blood glucose and macrovascular complications is not fully known, said Emily Weidman-Evans, PharmD, BC-ADM, CPE.
Dr. Weidman-Evans will present “How Sweet is Your Heart? Cardiovascular Effects of Diabetes Drugs” from 11:00 am to 12:00 pm today in Great Hall B. She will explain the implications of clinical trials as they relate to blood glucose control and cardiovascular outcomes, and she will examine the cardiovascular risk factors and effects of available diabetes drugs.
“We have a lot of medications that lower blood glucose, but they won’t necessarily save patients’ lives. Attendees should take part in this program if they have ever wondered what evidence is out there related to these drugs, the markers of cardiovascular health that they impact, and which ones actually have studies that show they affect cardiovascular outcomes, such as myocardial infarction or stroke,” said Dr. Weidman-Evans, clinical associate professor in the physician assistant program and a clinical pharmacist in family medicine and comprehensive care at Louisiana State University Health-Shreveport. She also will provide an example of a treatment plan for a person with diabetes considering glucose-lowering ability, while keeping in mind a drug’s cardiovascular risks and benefits.
She will look at the first- and second-line drugs recommended by the American Diabetes Association and American Association of Clinical Endocrinologists: metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 (DPP 4) inhibitors, alpha-glucosidase inhibitors, thiazolidinediones, sulfonylureas, meglitinides, and insulin.
Dr. Weidman-Evans offered guidance to diabetes educators who have patients with diabetes and a high CVD risk: Use metformin as a first line of therapy, avoid older sulfonylureas and rosiglitazone, consider pioglitazone and an alpha-glucosidase inhibitor as earlier options and GLP-1 RAs as a follow-up option.
She also recommended avoiding thiazolidinediones and probably DPP 4 inhibitors in those with heart failure, avoiding metformin in those with New York Heart Association Class III and IV disease, and using caution with sulfonylureas and insulin. In all patients with heart disease, she said to consider a higher A1C goal of 7.5 to 8.
“My hope is that attendees will leave this session more confident in explaining to patients, and other providers, why certain therapeutic choices have been made, based upon their cardiovascular risks,” Dr. Weidman-Evans said.