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Lower Your Blood Sugar Without Harming Your Heart

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Since just having diabetes puts you at increased risk for heart disease, it seems incredible that some diabetes medications have the side effect of increasing the risk for heart problems—but it’s true. Fortunately, that’s not the case for all diabetes drugs. Even better, researchers have now figured out that some diabetes medications may actually protect your heart.

Sodium-glucose cotransporter-2 inhibitors are a class of blood sugar–lowering drugs that gained attention recently when research found that they may be heart-protective. Some “SGLT-2i” drugs have been shown to reduce the risk for cardiovascular events—such as heart failure, heart attack and stroke—and of dying from cardiovascular causes. Other SGLT-2i drugs are still being evaluated in clinical trials. SGLT-2i drugs include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).

An international team of researchers wanted to see how SGLT-2i drugs compared with other glucose-lowering medications. They analyzed health records of more than 400,000 people with diabetes treated in South Korea, Japan, Singapore, Israel, Australia and Canada. Half of the patients were new users of an SGLT-2i and the other half were new users of other glucose-lowering agents. About 27% of these patients were known to have cardiovascular disease. While the study was funded by AstraZeneca, manufacturer of the SGLT2i drug Farxiga, it was published in a well-respected, peer-reviewed journal.

Results: Compared with other glucose-lowering agents, SGLT-2i drugs were associated with a 40% lower risk of dying from any cause or of being hospitalized for heart failure during about a one-year follow-up. SGLT-2i use was also associated with modest but statistically significant reductions in risk for myocardial infarction (heart attack) and stroke.

The study analyzed effects by drug class only—not by individual drugs, which may vary in terms of their effects on specific heart-related outcomes. Still, SGLT-2i drugs were the clear winners in this heart-health shoot-out.

Lifestyle changes, including diet and exercise, remain the foundation of type 2 diabetes management. But if you need extra help from a medication, discuss with your doctor whether an SGLT-2i would be a good idea—so you can protect your heart while managing your blood sugar. Note that these drugs’ side effects may include significantly reduced blood pressure (possibly making pressure too low in some people) and genital (yeast) infections, so as with all drugs, the risks need to be weighed in context with the rest of your health.

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Source: Mikhail Kosiborod, MD, cardiologist, Saint Luke’s Mid American Heart Institute and University of Missouri, Kansas City, and coauthor of study titled “Lower Cardiovascular Risk Associated with SGLT-2i in >400,000 Patients: The CVD-REAL 2 Study,” published in Journal of the American College of Cardiology. Dr. Kasiborod has received research funding and/or served as a consultant to AstraZenica, Boehringer Ingelheim, Janssen and Merck (Diabetes). Date: November 13, 2018 Publication: Bottom Line Health
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