November is Diabetes Awareness Month: Diabetes and cardiovascular disease

VMH Diabetes Education Team ... Heart disease is the leading cause of death for both men and women in the United States. People with diabetes are twice as likely to have heart disease or a stroke compared to someone who does not have diabetes. Pictured above is the Diabetes Team at Veterans Memorial Hospital including Angie Mettille, RN, BSN, Diabetes Educator, seated; Jill Fleming, RD/LD, Dietitian standing at left; and Brittney Snitker, Pharm.D., Pharmacist and Certified Diabetes Educator at Veterans Memorial Hospital. In this article, Snitker outlines the things those with diabetes can do to lower their risk of heart disease. Submitted photo.

by Brittney Snitker, Pharm.D., BCPS, CDE, Pharmacist and Certified Diabetic Educator, Veterans Memorial Hospital

Heart disease is the leading cause of death for both men and women in the United States. If you have diabetes, you are twice as likely to have heart disease or a stroke than someone who does not have diabetes.  There are many things you can do to lower your risk of heart disease. Diet and exercise are most important but when these are not enough, there are a few other medications that can help lower cardiovascular risk.

The diagnosis of diabetes alone, regardless of blood sugar control, increases the risk of having a heart attack to that of an individual without diabetes that has already experienced a heart attack.  The risk further increases when blood sugars are not controlled. Sodium glucose cotransporter-2 inhibitors (SGLT2s) and glucagon-like peptide-1 receptor agonists (GLP1s) are medications fairly new to diabetes management with some excellent cardiac benefits above and beyond their blood sugar control. The studies including these medications have shown reduced cardiovascular events, heart failure exacerbations, and associated hospitalizations.

The SGLT2 medications with cardiovascular benefit include canagliflozin (Invokana), empagliflozin (Jardiance), and dapagliflozin (Farxiga). The associated studies have shown up to a 20% decrease in heart attack and stroke events, a 39% decrease in associated hospitalizations, and a 38% decrease in cardiovascular death. These are pretty incredible results. These medications work to lower the blood sugar by helping the kidneys to filter out excess glucose.  The key word is excess and therefore they will not cause low blood sugars.  Side effects to be concerned about are genital infections, low blood pressure, and dehydration. If you are prone to any of these conditions, these medications may not be for you.

A second class of diabetes medications with cardiac benefits are GLP1s. These medications work by increasing GLP1 levels in the small intestines. GLP1 is a hormone that is made by the body after eating. It stimulates insulin production, therefore lowering blood sugars, and also causes one to feel full. This medication can cause some stomach upset and nausea due to the full feeling and with this usually comes weight loss. Other than stomach upset, these medications are generally very well tolerated and some are injected as infrequently as once weekly.

Medications in this class with cardiac benefits include liraglutide (Victoza), semaglutide (Ozempic), and dulaglutide (Trulicity). They have shown cardiovascular benefits including up to a 26% reduction in heart attack, stroke, or cardiovascular death.

In addition to medications that lower blood sugar, sometimes your doctor may recommend blood pressure or cholesterol medications even though you do not have hypertension or high cholesterol. These medications include statins and blood pressure medications like lisinopril and losartan.

Diabetes affects blood vessels and nerves that control the heart and provide blood to all of the essential organs to keep them functioning properly. High blood pressure, high cholesterol and high blood sugar contributes to blood vessel damage causing many of the long-term problems associated with diabetes. Statins and certain blood pressure medications are beneficial even if you do not have high cholesterol or high blood pressure, because they have demonstrated vascular benefits like reducing inflammation and subsequent vasculature damage leading to reduced cardiovascular events.

Even though blood sugars may be well controlled and you do not have high cholesterol or high blood pressure, there are many additional medications that may be beneficial to one with diabetes to reduce cardiovascular risk. If you are interested in changing your diabetes medications or think any of the medications mentioned above might be of benefit to you, discuss with your healthcare provider or diabetes education team.