New Class of Medication Holds Promise for the Intimate Connection Between Diabetes and Heart Disease

Dr. Matthew Cavender, Improving Outcomes Through Cardiovascular Research: “We wanted to determine what therapies are cardiovascular specific that can improve outcomes with patients with diabetes. On the flip side, we considered drugs primarily geared toward treating diabetes that could be effective in patients with coronary disease.”

New Class of Medication Holds Promise for the Intimate Connection Between Diabetes and Heart Disease click to enlarge Dr. Matthew Cavender at UNC Medical Center's Catheterization Lab

Diabetes is known as the strongest risk factor for cardiovascular disease. The connection is one that Department of Medicine Cardiologist Matthew Cavender, MD, MPH has closely considered, especially when it comes to a relatively new drug class for diabetes.

“My research is focused on the interaction between coronary artery disease and diabetes,” said Dr. Cavender. “Diabetes has long been a risk factor for cardiovascular disease, with conditions that contribute to a 50% higher risk. We’ve known this for a long time but until recently we haven’t had medications designed for diabetes that appeared to reduce cardiovascular events.” 

Dr. Cavender, who joined the UNC Division of Cardiology less than one year ago, has been recognized by Cardiology Today as one of Cardiology’s next generation of innovators in part for his contributions to a worldwide study that investigated SGLT2-inhibitors. The study, known as CVD-REAL, examined patient outcomes from 300,000 patients across the US, UK, Sweden, Norway, Denmark and Germany. It was presented at the recent American College of Cardiology meeting in Washington, DC. 

“We have known that cardiovascular specific therapies can improve outcomes in patients with diabetes. In this study, we considered drugs primarily geared toward treating diabetes that could be effective in reducing cardiovascular events in patients with diabetes.”

Dr. Cavender was one of two cardiologists in the investigation sponsored by AstraZeneca that looked at three SGLT2-inhibitors: empagliflozin, canagliflozin and dapagliflozin. The study considered the association between these medications and hospitalization for heart failure and mortality, compared to medicines such as DPP-4 inhibitors, metformin and insulin, commonly used to treat type 2 diabetes.

“We found that the results in each country, regardless of which compound predominates, had lower rates of hospitalization for heart failure and had lower rates of cardiovascular death when treated with a SGLT2-inhibitor. In fact, SGLT2-inhibitors reduced the rate of hospital admission for heart failure or death from heart failure by almost 50%.”

Identifying a class of medications that shows reductions in cardiovascular events is a significant finding for patients with diabetes. That’s because heart disease is the primary cause of death in people with diabetes, not necessarily complications with their diabetes. Although more trials are underway, Dr. Cavender believes SGLT2-inhibitors will become one of the preferred treatments for patients with diabetes, especially those who are at high risk for cardiovascular events. The results also demonstrate the strength of intra professional medicine teams.