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More than 425 million people are affected by diabetes worldwide and this figure will likely grow to 629 million by 2045 if nothing is done.1 People with diabetes are 2 to 3 times more likely to have cardiovascular disease (CVD) than those without CVD. Indeed, among middle-aged people with type 2 diabetes living in high- and middle-income countries, up to 27 people out of 1,000 die from CVD each year; a third of them die from stroke and one quarter from coronary artery disease. The economic burden is also huge—in low- and middle-income countries, it has been estimated that USD 84 billion of gross domestic product was lost due to CVD and diabetes in the 10 years from 2005 to 2015.
Since 2007, the ESC and the European Association for the Study of Diabetes (EASD) have joined forces to write guidelines on the management of diabetes, pre-diabetes and CVD. Professor Francesco Cosentino (Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden) thinks these guidelines may have played a major part in changing how cardiologists now approach patients with type 2 diabetes. He says, “Previously, considering diabetes as a risk factor for CVD was delegated to endocrinologists when they treated hyperglycaemia, but now, cardiologists are taking their place alongside endocrinologists in a team effort, realising there must be collaboration across specialities for the benefit of patients.”
Regulatory authorities are also becoming more aware of the cardiovascular effects of glucose-lowering agents and from 2008, they issued mandatory guidelines requiring evaluation of the cardiovascular safety for all new therapies to treat type 2 diabetes in order to rule out excess cardiovascular risk. Prof. Cosentino explains, “Since then, many cardiovascular outcomes trials have been performed, accruing a very large body of evidence, with more than 160,000 patients enrolled. These trials highlight that some glucose-lowering treatments have a neutral effect on cardiovascular risk, while certain drugs within the new classes of glucagon-like peptide receptor agonist (GLP-1RA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors exert very important cardioprotective effects, significantly reducing major clinical hard endpoints, including myocardial infarction, stroke and cardiovascular death.”
Cardiovascular outcomes trials were initially conducted predominantly in patients with diabetes and established CVD, looking at secondary prevention of cardiovascular events, but there has been a shift in recent times towards the primary prevention setting, including patients without established CVD who are at high cardiovascular risk due to the presence of multiple risk factors. Based on very recent data, the beneficial effects of specific SGLT2 inhibitors and GLP-1RAs appear to be observed in both settings.
Prof. Cosentino describes further benefits: “Patients with diabetes are at very high risk of developing heart failure. Reductions in the occurrence of hospitalisation for heart failure have also been seen with certain new glucose-lowering agents, particularly in trials with SGLT2 inhibitors. These are really important findings, related to reducing both the clinical and economic impact of diabetes.”
All the evidence on cardiovascular safety has been considered by the latest ESC and EASD Task Force and been used to inform a very timely update of the 2013 guidelines—the 2019 recommendations will be presented tomorrow at ESC Congress 2019 and published simultaneously.
The ESC together with the European Association of Preventive Cardiology (EAPC) also provide the ‘Diabetes and CVD Programme’ (https://www.escardio.org/Education/Diabetes-and-CVD), a collection of educational resources, including webinars, ‘how-to’ articles, literature reviews and recommended reading. Prof. Cosentino, who is Co-Chair of the Programme Oversight Committee, feels strongly that a ‘go-to’ place is needed as a platform for the latest knowledge on the topic. “We initiated this programme to disseminate new findings as they are discovered, not only among cardiologists but for other healthcare professionals. New therapeutic solutions exist—healthcare professionals need to stay informed and incorporate advances into clinical practice as soon as possible so that the benefits can begin to be transmitted to in-need patients.”
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The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.
About ESC Congress 2019
ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2019 takes place 31 August to 4 September at the Paris Expo Porte de Versailles, Paris - France. Explore the scientific programme.
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