Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes

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Abstract

The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease.

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Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

Bernard Zinman, Christoph Wanner, John M. Lachin … (2015)

The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.

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Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

John J.V. McMurray, Scott D. Solomon, Silvio E Inzucchi … (2020)

In patients with type 2 diabetes, inhibitors of sodium-glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes.

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Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

Bruce Neal, Vlado Perkovic, Kenneth Mahaffey … (2017)

Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results The mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% confidence interval [CI], 0.75 to 0.97; P<0.001 for noninferiority; P=0.02 for superiority). Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77). Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal. Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal. (Funded by Janssen Research and Development; CANVAS and CANVAS-R ClinicalTrials.gov numbers, NCT01032629 and NCT01989754 , respectively.).

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Journal

Journal ID (nlm-ta): Eur Cardiol

Journal ID (iso-abbrev): Eur Cardiol

Journal ID (publisher-id): ECR

Title: European Cardiology Review

Publisher: Radcliffe Cardiology

ISSN (Print): 1758-3756

ISSN (Electronic): 1758-3764

Publication date (Electronic): 19 April 2021

Publication date Collection: February 2021

Volume: 16

Electronic Location Identifier: e14

Affiliations

[1. ] National Heart Centre Singapore

[2. ] Sengkang General Hospital Singapore

[3. ] Kitasato University and Hospital Tokyo, Japan

[4. ] Cleveland Clinic Abu Dhabi United Arab Emirates

[5. ] Monash University Melbourne, Australia

[6. ] Cardiac Sciences, Kokilaben Hospital Mumbai, India

[7. ] Rajavithi Hospital, Rangsit Medical School Thailand

[8. ] Department of Critical Care Medicine, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan

[9. ] School of Medicine, National Yang-Ming University Taipei, Taiwan

[10. ] Department of Physical Therapy, Fooyin University Kaohsiung, Taiwan

[11. ] Ripas Hospital Brunei

[12. ] Batra Hospital and Medical Research Centre New Delhi, India

[13. ] Korea University College of Medicine Seoul, South Korea

[14. ] The Chinese University of Hong Kong Hong Kong, China

[15. ] Siriraj Hospital Mahidol University, Bangkok, Thailand

[16. ] Farrer Park Medical Centre Singapore

[17. ] University of Santo Tomas Manila, the Philippines

[18. ] Department of Cardiology, Vietnam National Heart Institute Hanoi Medical University, Hanoi, Vietnam

[19. ] Penang General Hospital Penang, Malaysia

[20. ] Seoul National University Bundang Hospital Seongnam, South Korea

[21. ] Shanghai Jiatong University Shanghai, China

[22. ] Pantai Hospital Kuala Lumpur Kuala Lumpur, Malaysia

[23. ] Udayana University Bali, Indonesia

[24. ] Department of Medicine Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

[25. ] Yong Loo Ling School of Medicine National University of Singapore, Singapore

[26. ] Institut Jantung Negara Kuala Lumpur, Malaysia

[27. ] Peking Union Medical College Beijing, China

[28. ] Division of Cardiovascular Medicine University of the Philippines, Philippine General Hospital, University of the Philippines Manila, Manila, the Philippines

[29. ] Singapore General Hospital Singapore

Author notes

Disclosure: This work was funded through the Asian Pacific Society of Cardiology, with unrestricted educational grants from Abbott Vascular, Amgen, AstraZeneca, Bayer and Roche Diagnostics. JWCT reports honoraria from AstraZeneca, Bayer, Amgen, Medtronic, Abbott Vascular, Biosensors, Alvimedica, Boehringer Ingelheim and Pfizer; research and educational grants from Medtronic, Biosensors, Biotronik, Philips, Amgen, AZ, Roche, Otsuka, Terumo and Abbott Vascular; and consulting fees from Elixir and CSL Behring. DS reports honoraria from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Medtronic, Menarini, Merck, Novartis, Otsuka, Pfizer, Roche and Servier. JA reports honoraria from AstraZeneca, Daiichi Sankyo, Bayer and Sanofi, and grants/grants pending from Daiichi Sankyo. MEC reports honoraria, speaking fees or grants from MSD/Merck, Novo Nordisk, AstraZeneca, Boehringer-Ingelheim, Lilly, Bayer, Servier, Novartis and MundiPharma. JJD reports honoraria from Bayer and Pfizer. SJ reports honoraria from Biosense Webster and Medtronic. DKQ reports honoraria from AstraZeneca and Boehringer Ingelheim. BJM reports honoraria and CME grants from AstraZeneca, Boehringer Ingelheim, Lilly-Zuellig, MSD, Novartis, Novo Nordisk, Upjohn-Pfizer, Sanofi, and Servier. CKT reports honoraria from AstraZeneca, Boehringer Ingelheim, Novartis and Johnson & Johnson. SGK reports consulting/lecture fees or research grants from AstraZeneca, Boehringer Ingelheim, MSD, Pfizer, Takeda, Sanofi, Novo Nordisk, Novartis and Abbott. CD reports honoraria from AstraZeneca, Abbott, Bayor, Boehringer, Pfizer and Sanofi Aventis. BWT reports honoraria and consulting fees from Astellas, AstraZeneca, Boehringer Ingelheim and Otsuka. APSK reports honoraria from Abbott, AstraZeneca, Bayer, Eli Lilly and Company, Merck Serono, Nestle, Novo Nordisk, Pfizer and Sanofi. EBR reports consulting fees and speaker’s honoraria from Corbridge, Boehringer Ingelheim, E Merck, Torrent, Innogen and Servier, and research grants from MSD, Novartis and Pfizer. SYG reports advisory board honoraria from AstraZeneca, Boehringer Ingelheim, Bayer, Novo Nordisk and Sanofi. All other authors have no conflicts of interest to declare.

Correspondence: Jack Wei Chieh Tan, National Heart Centre, 5 Hospital Dr, Singapore 169609. E: jack.tan.w.c@ 123456singhealth.com.sg

Article

DOI: 10.15420/ecr.2020.52

PMC ID: 8086420

PubMed ID: 33976709

SO-VID: 10c3bb08-3af5-4d5a-a431-83bba33ef558

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Date received : 23 December 2020

Date accepted : 15 February 2021

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Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes

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Most cited references 70

Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

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