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In part 1 of this Exclusive Interview, Javed Butler talks with Diabetes in Control Publisher Steve Freed about diabetes heart failure and the use of SGLT to lower risk of heart disease.
Javed Butler, MD, MPH, MBA, is a cardiologist, professor, and chairman of medicine at the University of Mississippi Medical Center.
Transcript of this video segment:
Freed: This is Steve Freed and we’re here with Diabetes in Control, and we’re at the American Diabetes, 78th Scientific Sessions Meeting, and we have a very special guest. So we’re here today with Javed Butler, is that correct? MD, MPH, MBA. And maybe we can start off with, tell us a little bit about yourself and your practice.
Butler: So, I’m a cardiologist. My primary focus is heart failure transplant and my research focus is clinical trials and heart failure, mostly looking at Phase 2 clinical trials. I recently moved from New York to Jackson, Mississippi where I’m Chairman of Medicine at the University of Mississippi.
Freed: And I think the title of your presentation was Heart Failure Outcomes in Diabetes Cardiovascular Outcomes Trials and Evolving Landscape.
Butler: Yes.
Freed: And maybe we can start out with, give us the luxury of the high points of your presentation. What you want medical professionals to walk away with? Because I once saw a presentation about what makes a good presenter, and that is when people walk away and take your information and use it in their practice. And maybe you can give us some information that our readers and viewers will use in their practice.
Butler: Well, thank you very much first for the invitation to be with you today. If I were to summarize my entire presentation in two sentences, I would say, one, that while reduction in hemoglobin A1C is very important, and sort of the main goal of heart failure therapy, you’re not done improving patient’s long-term outcomes, and cardiovascular outcomes, which is the number one cause of morbidity-mortality in patients with diabetes is very, very important. So, our therapeutic approach to these patients should not be limited only to management of glucose but management of their cardiovascular risk. And the second sentence will be, that while for the longest time when we talk about cardiovascular risk, we have talked more about vascular risk which is myocardial infarction and stroke in subsequent cardiovascular mortality. But we are learning more and more how heart failure outcomes either through or alternate pathways from vascular disease may lead to adverse outcomes and then we have to think about heart failure outcomes as well and not only atherosclerotic outcomes.
Freed: Well, you must be excited about some of the new drug treatments that are out there, especially in diabetes when it comes to heart failure and death. Before I get into your questions, what is your thought process behind using the SGLT2s and the GLP-1s to lower the risk for people with diabetes as far as heart disease and even death?
Butler: Yeah. So, at least the high risk cardiovascular patients, we have enough data right now from the cardiovascular outcomes trial that, beyond glucose control, now we have therapies that modulate their cardiovascular risk also, but you don’t give anything up by doing so because microvascular risk reduction will occur nevertheless because of glucose control. So, now we have two classes of drugs, GLP-1 agonist, at least two of them, and SGLT2 inhibitors, two of them that have data which are out there to modulate cardiovascular risk. Now, there are a lot of sort of subtleties and nuances that some improved this kind of outcome, some improved that kind of outcome, but nevertheless at least we have some of the options. So, one issue is how do you preferentially give therapies in high risk patients that can improve outcomes? But also some of the classic therapies, at least putting the heart failure lens on, may have raised some concerns that they may actually worsen outcome as well. So, it’s a pretty broad feel right now to think through what is the best way to treat your patients with diabetes.