Issue link: https://viewer.e-digitaledition.com/i/837588
D I A B E T E S C A N A S mu c h a s q u a- d r uple a n a du lt 's r isk of dy i n g f rom hea r t at tack, stroke or a not her for m of ca rdiova scu la r disea se, according to t he A mer ica n Hea r t A ssociation . Ca rdiovascula r disease is the leading cause of death for people w ith diabe- tes, a nd t he medica l com munit y ha s lon g sou g ht t o reduce it s ef fec t s on these patients — historica lly, without much succes s , a ccord i n g t o S t even Nissen, MD, Cha ir of Ca rdiova scula r Medicine at Clevela nd Clinic. " For a long, long time, t here wa s a tremendous focus on lowering blood suga r," Dr. Nissen says. " W h i le it is cer t a i n ly a good idea to lower blood suga r because it has effects on micro- v a s c u l a r d i s e a s e [a s s o c i a t e d w it h diabetes] — retinopathy, neuropathy, k id ney d i sea se — it t u r n s out t here is not a strong relationship bet ween lowering blood suga r a nd a reduction in morbidit y a nd mor ta lit y from mac- rovascula r disease." T he F DA-m a nd at ed E M PA-R EG OUTCOME tria l demonstrated that empaglifl ozin, one of a class of sodium- glucose cotransporter-2 inhibitors, was more e" ective than placebo in reducing cardiovascular-related complications and death in patients with Type 2 diabetes and established cardiovascular disease. More than 7,000 patients were randomized to receive empaglifl ozin or placebo once a day for about three years. Empaglifl ozin reduced cardiovascular death by 38 percent, and the study's primary endpoint — death from cardiovascular causes, nonfatal heart attack or nonfatal stroke — by 14 percent. It also reduced hospital admissions for heart failure by 35 percent. Empaglifl ozin is the fi rst drug to lower glucose a nd improve ca rdiovascula r outcomes, a breakthrough that earned it inclusion in Cleveland Clinic's list of Top 10 Medical Innovations Most Likely to Be Game Changers for 2017. "To have a drug that has this benefi t of reducing both morbidity and mortality, particularly mortality ... is pretty impres- sive," Dr. Nissen says. "Of all the things [clinicians] do for patients, living longer is the thing that's fi rst on people's minds. Empaglifl ozin isn't the fi rst drug in this class, but it's the fi rst to show these ben- efi ts. There are three or four other drugs that work by the same mechanism that haven't fi nished their trials yet. If it were the entire class that o" ered these benefi ts, that would be wonderful." CLEAR MODE OF ACTION, MURKY MECHANISM OF BENEFIT Empaglifl ozin interferes with the kidneys' reabsorption of glucose that they fi lter BY THOMAS CROCKER A MA JOR TRIAL DEMONSTR ATED THE GLUCOSEžLOWERING DRUG EMPAGLIFLOZIN REDUCES CARDIOVA SCUL AR MORBIDIT Y AND MORTALIT Y IN INDIVIDUALS WITH T YPE 2 DIABE TES AND E XISTING CARDIOVA SCUL AR DISE A SE. CLINICIANS AND RESE ARCHERS DISCUSS HOW IT DOES SO AND WHO IS MOST LIKELY TO BENEFIT. A TR ANSFORMATIVE APPROACH EMPAGLIFLOZIN: TO DIABETES? 1 4