New York: The treatment of coronary artery disease (CAD) patients with type 2 diabetes (T2D) may need to be more aggressive compared with those without diabetes to reduce other complications, according to a new study.
“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 study researcher Suzanne V Arnold from the University of Missouri in the US.
“What we’ve learned 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,” Arnold added.
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 in the paper, published in the journal Circulation.
Metformin is the most frequently recommended medication for initial treatment to lower glucose in people diagnosed with T2D. Metformin sometimes leads to mild weight loss, is at least neutral in terms of cardiovascular effects, is inexpensive and has a long use and safety history.
However, the statement noted that the latest research indicates several newer classes of medications may both lower glucose and reduce the risk of cardiovascular diseases.
Sodium-glucose co-transporter inhibitors (SGLT2 inhibitors), which are oral medications, were the first class to show clear benefits on cardiovascular outcomes. In a recent study of people with T2D and a diagnosis of heart disease, researchers found that patients taking SGLT2 inhibitors were significantly less likely to die of cardiovascular disease.
They had a reduced risk of heart failure, less progression of chronic kidney disease and also lost weight. The vast majority of patients with T2D have hypertension. Blood pressure control is critically important in the management of CAD in patients with T2D.
More aggressive steps may be needed to improve the cholesterol levels in people with T2D.
“Statins, the cornerstone of cholesterol-lowering therapy, may slightly increase blood sugar levels, however, the overall cardiovascular risk reduction they provide is far more beneficial. Blood sugar changes are not a reason to avoid prescribing statins for people with type 2 diabetes,” said Arnold.
Some patients with CAD and T2D may also benefit from lowering cholesterol with additional classes of medications, such as oral cholesterol absorption inhibitors or newer injectable medications, which have been shown to be beneficial in people with diabetes.
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.
