Browsing: Cardiovascular

Cardiovascular outcomes, heart failure, cardio-renal protection, hypertension, and lipid-lowering trials in diabetes and endocrinology.

The Swedish Obese Subjects (SOS) study demonstrated that bariatric surgery is associated with a 29% reduction in adjusted all-cause mortality compared with conventional obesity treatment over an average 10.9 years of follow-up, with reductions in both cardiovascular and cancer deaths, providing the first prospective controlled evidence for the long-term survival benefit of surgical weight loss.

The Look AHEAD trial demonstrated that intensive lifestyle intervention targeting weight loss in overweight or obese adults with type 2 diabetes did not reduce cardiovascular events over 9.6 years despite clear differences in weight, fitness, and glycaemic control, establishing a critical negative result that informed the rationale for pharmacological obesity treatment with greater weight loss efficacy.

The SELECT trial demonstrated that semaglutide 2.4 mg reduces 3-point MACE by 20% in overweight or obese adults with pre-existing cardiovascular disease and no diabetes, becoming the first obesity pharmacotherapy trial to demonstrate a hard cardiovascular endpoint benefit and establishing GLP-1 receptor agonism as a cardiovascular intervention in non-diabetic obesity.

The REWIND trial demonstrated that dulaglutide reduces 3-point MACE in a broad type 2 diabetes population of which 69% had no established cardiovascular disease, with a significant 24% reduction in nonfatal stroke and consistent renal benefit, extending GLP-1 receptor agonist cardiovascular protection into a primary prevention context.

The LEADER trial demonstrated that liraglutide significantly reduced 3-point MACE and cardiovascular mortality in patients with type 2 diabetes and high cardiovascular risk, becoming the first GLP-1 receptor agonist CVOT to demonstrate superiority and characterising an atherosclerotic rather than heart failure protection profile distinct from SGLT2 inhibitors.

DAPA-CKD demonstrated that dapagliflozin reduced the composite of a sustained 50% or greater eGFR decline, end-stage kidney disease, or renal or cardiovascular death by 39% in patients with albuminuric CKD with or without type 2 diabetes, extending nephroprotective SGLT2 inhibition beyond diabetic nephropathy to a broad CKD population for the first time.

EMPEROR-Reduced confirmed that empagliflozin reduces cardiovascular death or hospitalisation for heart failure by 25% in patients with HFrEF irrespective of diabetes status, while also demonstrating a 50% reduction in a renal composite outcome and a markedly slower rate of eGFR decline, adding critical confirmatory evidence for SGLT2 inhibitors as standard-of-care in HFrEF.

The DAPA-HF trial demonstrated that dapagliflozin reduced the composite of worsening heart failure or cardiovascular death by 26% in patients with heart failure and reduced ejection fraction, with consistent benefit observed in both those with and without type 2 diabetes, establishing SGLT2 inhibition as a core therapy for HFrEF independent of glycaemic status.