Drug Topics - August 4, 2008 - (Page 4) 4 DRUG TOPICS August 4, 2008 www.drugtopics.com Of Interest to Pharmacists Researchers still studying impact of glycemia on heart disease Dennis Blank lthough the results of several studies are pending, evidence so far shows that drugs that lower glycemic levels in diabetic patients also lessen their risk of heart attacks. “Does diabetes increase the risk of cardiovascular disease (CVD)-related deaths?” Faramarz Ismail-Beigi, M.D., a specialist in diabetes and endocrinology in Cleveland and chief of endocrinology at Case Western Reserve University, asked. “The answer is definitely, ‘Yes.’” However, he noted, there was still not enough evidence to attribute CVD deaths to glycemia. Ismail-Beigi and other physicians participated in a special symposium at the George Grunberger, American Association of Clinical EndroM.D., addressses A ACE on st udies crinologists (AACE) annual meeting in relating to glucose control in cardiovascular Orlando, Fla., to consider whether reduction of glycemia with drug intervention can disease. reduce the risk of CVD. “There is a lot of information out there that is confusing to patients,” Etie Moghissi, M.D., chair of the symposium, said. “As experts in diabetes care, it is the endocrinologist’s job to make sure the patients have the facts.” As Beigi and other panel members noted, not all of the studies done so far support the contention that hyperglycemia is a risk factor in coronary heart disease. George Grunberger, M.D., a Wayne State University, School of Medicine clinical professor and founder and chairman of the Grunberger Diabetes Institute (GDI), said there are benefits from using certain drugs and changing diet. “Intensive intervention with multiple drug therapies and behavior modifications had sustained beneficial effects,” Grunberger said about the results of the BARI D study. The 160 patients who participated in the study over a four-year period had significant reductions in CVD and stroke, and the percentage of those who died was less than the control group. In addition, these patients were given a healthy diet of vegetables, fruit, seafood, walnuts, and almonds. The importance of the connection between CVD and diabetes was cited by one physician. “The mortality rate of a diabetes patient who has experienced a heart attack is approximately double that of the non-diabetic patient,” David Bell, M.D., a member of AACE, said. “Type 2 diabetes patients have as much chance of having a myocardial infarction as a non-diabetic patient who has already A THE AUTHOR is a writer based in Orlando, Fla. Photo: Dennis Blank had one. Therefore, it is necessary to regard the diabetes patient as a cardiac patient during treatment.” The researchers participating in the symposium also discussed the impact of stopping the ACCORD study this year because of excess deaths. The trial involved Type 2 diabetics with a high risk of heart disease. It raised questions about lowering blood glucose levels to near normal levels. In the trial, older patients who had underwent intensive therapy aimed at achieving glucose levels of 6% or lower had higher rates of death than a group in the same study that had been treated more conservatively. “The study was designed to ask the question, ‘If you really control blood sugar, do you actually prevent death?’” Ismail-Beigi, one of the researchers in this study, had said in an earlier interview with Drug Topics. “I think in the intensive group, the answer is, ‘No.’ It doesn’t prevent heart attacks and stroke. “Intentionally reducing blood sugar below current clinical guidelines causes harm in especially highrisk patients with Type 2 diabetes,” Ismail-Beigi said. “There is no evidence that any medication or combination of medications are responsible for the higher risk of death.” There is still not enough information about the cause of death in diabetic CVD patients to “attribute death to hypoglycemia,” Ismail-Beigi said. “At this point, the final answer is, ‘No,’ but that answer may change.” Lawrence Blonde, M.D., director of the Ochsner Diabetes Clinical Research Unit in New Orleans, participated in the symposium and said there is strong interest in the outcome of ACT NOW, a four-year study of 600 patients using pioglitazone, a drug that reduces the amount of sugar in the blood. The results should be available soon. The study was premised on the belief that pioglitazone treatment administered to people as they develop diabetes will prevent blood glucose levels from rising. There is evidence that that drug may also prevent atherosclerosis. In addition, Blonde said researchers are awaiting the outcome of the NAVIGATOR study, which is evaluating the outcome on 7,500 people over the age of 50 that had been given nateglinide, an anti-diabetic agent, to see if it reduces the incidence of CVD. http://www.drugtopics.com
Table of Contents Feed for the Digital Edition of Drug Topics - August 4, 2008 Drug Topics - August 4, 2008 Contents To Prevent Drug Errors, Go to the Source Researchers Still Studying Impact of Glycemia on Heart Disease First Dementia Treatment Guidelines Released Drug Topics - August 4, 2008 Drug Topics - August 4, 2008 - Contents (Page 1) Drug Topics - August 4, 2008 - Contents (Page 2) Drug Topics - August 4, 2008 - To Prevent Drug Errors, Go to the Source (Page 3) Drug Topics - August 4, 2008 - Researchers Still Studying Impact of Glycemia on Heart Disease (Page 4) Drug Topics - August 4, 2008 - First Dementia Treatment Guidelines Released (Page 5)
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