BIG news in the diabetes world was released on Friday – for the first time, a medication in the class called GLP-1 receptor agonists, called liraglutide (trade name Victoza), has been shown to reduce cardiovascular events in people with type 2 diabetes.
The LEADER trial enrolled over 9000 people with type 2 diabetes, who were at high risk of cardiovascular disease, and randomized them to receive either Victoza vs placebo with usual standard of care.
They found that Victoza was better than placebo to reduce the combination of death from cardiovascular disease, non-fatal heart attack and non-fatal stroke. A reduction in all three of these components contributed to the benefit that was seen. The numbers and details are not yet available – we’ll have to wait until the American Diabetes Association meeting in June to find out more.
Here’s why this is ground-breaking news:
We have long been uncertain whether we are actually preventing cardiovascular disease by treating diabetes – we know that the higher sugars are, the higher the risk of heart disease, but it has been evasive to actually prove that lowering blood sugars prevents heart disease. The next question is whether some medications to treat type 2 diabetes could be better (or worse) than others to protect from heart disease. LEADER has now shown us that treating type 2 diabetes with liraglutide does indeed protect patients from cardiovascular events.
Within the GLP1 receptor agonist group of medications, a study of lixisenatide (called the ELIXA study) showed that it did not increase the risk of cardiovascular events, but it didn’t prevent them either. Studies of the other GLP1 receptor agonists available are currently underway.
As far as other type 2 diabetes medications go, the only other medication that has clearly been shown to reduce cardiovascular disease is empagliflozin, which you can read more about here and here. Metformin, which is the #1 treatment advised for type 2 diabetes worldwide, has some weak evidence that it prevents cardiovascular events as well.
We will be waiting in anticipation for more details from the LEADER trial in June!
Disclaimer: I have been involved in research trials of liraglutide. I receive honoraria as a continuing medical education speaker and consultant from the makers of liraglutide (Novo Nordisk). I am involved in research of medications similar to liraglutide for the treatment of type 2 diabetes.