In the rapidly evolving field of cardiology, evidence has shown the proven benefits of sodium-glucose co-transporter 2 (SGLT2) inhibitors for patients with cardiovascular disease (CVD), as well as those with diabetes and CVD. atherosclerotic.
In an interview with HCP LiveChristopher Granger, MD, Professor of Medicine, Duke University School of Medicine, discussed his recent presentation on integrating SGLT2 inhibitors into practice at the 30th Annual Beaumont Cardiovascular Conference in Beaver Creek.
Granger pointed to data from the EMPA-REG study on empagliflozin showing substantial benefit in reducing heart failure events, as well as all-cause mortality and other CV outcomes leading SGLT2i to become a recommendation. class 1A for patients with diabetes and ASCVD.
He also noted the DAPA-HF trial in chronic heart failure with low ejection fraction where all CV results were improved and confirmed with empagliflozin.
Next, Granger highlighted the EMPEROR-Preserved, which investigated empagliflozin for patients with chronic heart failure and ≥ 45% ejection fraction as one of the newest and most exciting trials .
“In this population, there were substantial benefits as well,” Granger said. “This is truly the first-ever trial to show significant substantial benefit of a drug for patients with mid-course heart failure with preserved ejection fraction. So it really totally changed the landscape.
Overall, Granger noted, the data showed impressive and improved results, but the agents are significantly underused in the population for which there are proven benefits.
“One of those hurdles is just that cardiologists haven’t fully embraced these drugs yet,” Granger said. “Probably my main point at the Beaver Creek conference in regards to these drugs is that cardiologists need to take the ball, they need to feel empowered, empowered and accountable for the use of these drugs, because these are not Diabetes drugs. They’re really cardiovascular drugs, that’s their main benefit.
He also mentioned cost as a barrier as the drugs are quite expensive. But, like DOACs, sacubitril valsartan and PCSK9 inhibitors, Granger noted the need for a mechanism that helps patients get pre-approved through insurance and find other opportunities to make medicines affordable for patients.
“To close this gap, we really need to address three sets of barriers, one at the clinician level, another at the patient level, and the third at the system level,” Granger said.
He further pointed to COORDINATE-Diabetes, a randomized trial group of cardiology clinics in the United States working to overcome barriers and move the needle to obtain agents such as SGLT2 inhibitors and receptor agonists. GLP-1 used more consistently in practice.
As for the timeline of when more patients might use the drugs, Granger hoped the rate would increase significantly, from around 20% now to 50% over the next two years.
“The only way to do that is to educate a lot, to hire cardiologists and primary care doctors, it’s the doctors and the providers who see these patients and prescribe them,” he said. “It’s not the endocrinologist, so we can’t leave this to the diabetes care specialists, we have to deal with it ourselves.”