AHA Recommends More Aggressive Therapies for Patients with Both Diabetes and Heart Disease

In their scientific statement released on Monday, the American Heart Association (AHA) suggested that type 2 diabetes (T2D) may need to be treated more aggressively when patients have both coronary artery disease (CAD) and T2D.

The statement additionally outlines medications, procedures, and lifestyle change recommendations in order to help reduce the risk of heart attack and complications in patients with both T2D and CAD.

“Recent scientific studies have shown that people with T2D may need more aggressive or different medical and surgical treatments compared to people with CAD who do not have T2D,” said Suzanne V. Arnold, MD, MHA, chair of the writing group for the scientific statement, associate professor of medicine at the University of Missouri Kansas City, and a cardiologist at Saint Luke’s Mid America Heart Institute, in Kansas City, Missouri.

T2D is often associated with being overweight or obese, having high blood pressure, and high cholesterol, which function to increase the risk of cardiovascular disease, according to the American Heart Association. The dual management of T2D and CAD may require much more than simply lowering one’s glucose to healthy levels; more encompassing evaluations are necessary to address each patient’s individual risk for additional complications.

“What we’ve learning in the past decade is how you control glucose levels has a huge influence on cardiovascular risk. Lowering blood sugars to a certain level is not sufficient. There are now more options for controlling glucose in people with T2D, and each patient should be evaluated for their personal risk of cardiovascular disease, stroke and kidney disease. This combined health information as well as the patient’s age should be used to determine the appropriate therapies to lower glucose,” Arnold said.

AHA’s statement mentions newer classes of T2D medications that may eclipse metformin, the medication used most frequently for initial treatment to lower glucose, in terms of their ability to also reduce the risk of cardiovascular disease (CVD). These medications include sodium-glucose co-transporter 2 (SGLT2) inhibitors, in which a recent study identified not only clear benefits in reducing CVD, but also reduced risk of heart failure, lowered chronic kidney disease progression, and stimulated weight loss.

Other treatments mentioned include glucagon-like peptide-1 (GLP-1) receptor agonists which have shown mixed results in CVD risk reduction benefit, as well as relaxing glycemic control for older adults with T2D and CAD for reducing one’s risk of hypoglycemia. “Hypoglycemia is incredibly hard on the heart and should be avoided particularly in older patients. We must ensure that we are weighing all of the options in consideration of the whole patient, keeping in mind that what may be appropriate for a 60-70 year old patient is likely not the same as for an 85-year-old,” said Arnold.

The AHA stresses the importance of pursuing a healthy lifestyle in patients with T2D and CAD.

“While treatment with medication is very important in the treatment of people who have both T2D and CAD, no pill is a substitute for a healthy lifestyle. No matter what new medicines there are, a heart-healthy diet, achieving and maintaining a healthy weight, regular physical activity and treating sleep disorders remain the major cornerstones of treatment for T2D and cardiovascular disease,” said Arnold.

AHA’s statement was published in their flagship journal Circulation.

References:

People with type 2 diabetes and heart disease may benefit from newer therapies. News Release. American Heart Association; April 13, 2020. Accessed April 15, 2020. . https://newsroom.heart.org/news/people-with-type-2-diabetes-and-heart-disease-may-benefit-from-newer-therapies?preview=94ff.