Diabetes and Heart Disease Among Minority Populations

I'm dr. Keith C Ferdinand professor of medicine at the Tulane University School of Medicine in cardiology at the Tulane Heart and Vascular Institute today I'm talking about diabetes and cardiovascular care if you look at persons who have diabetes specifically type 2 diabetes the number one cause of death is not poor control of glucose but actually ischemic heart disease persons with diabetes die more from ischemic heart disease than from any other cause if we look at the control of glucose itself it may have benefits specifically for micro vascular disease that is retinopathy kidney disease and maybe even prefer arterial disease but for macro vascular disease major heart attacks and dying from heart failure this is the most common cause of death for adults with diabetes some of the newer data using for instance the sglt2 inhibitors with emperor egg show that there is a decrease in overall cardiovascular death total mortality and a decrease in hospitalization for heart failure in the same lines with Kanaka flows and in the canvas study there was a 40% decrease in the aggregate of a progression to in stage renal disease renal failure and death therefore the appropriate treatment of persons with type 2 diabetes is more than just simply controlling glucose in fact some of the studies now suggest that there will be a worldwide epidemic of diabetes as many as 400 million people across the globe by 2025 there will not be enough endocrinologist to actually control this particular condition unfortunately racial and ethnic minorities are often underrepresented in clinical outcomes trials therefore I led an initiative to have a study done in a high-risk population who had both hypertension and type 2 diabetes african-americans in this particular study with 150 persons who had uncontrolled diabetes with a hemoglobin of a1c from eleven and uncontrolled hypertension with systolic blood pressure of 140 to 180 we enrolled patients and randomized them to either placebo or implica folding starting at 10 milligrams and increasing to 25 milligrams the patients then had ambulatory blood pressure monitoring done because implica frozen is an anti diabetic medicine the primary outcome was 24 weeks decrease in hemoglobin a1c which was met from a baseline hemoglobin a1c of approximately 8.5 with the decrease of 0.78 nevertheless they were pre-specified incomes nevertheless there were pre-specified outcomes specifically related to blood pressure using ambulatory blood pressure mounting which is a valid way of measuring the effects of blood pressure for any medication we saw a statistically significant decrease of approximately six millimeters in the systolic blood pressure on ambulatory blood pressure monitoring at 12 weeks which was maintained for 24 weeks the clinic blood pressure was decreased approximately four millimeters of mercury this was not statistically significant but clinically meaningful even more importantly after 24 weeks the clinic blood pressure also decreased statistically there was also a loss in body weight with implica Folsom therefore the sglt2 s may be beneficial in african-american patients who have both hypertension and diabetes while not a cardiovascular outcomes trial our abstract published in Jax suggested that there may be a real benefit in blood pressure reduction and control of glucose with the bonus of some degree of weight loss using implica Folsom and sglt2 inhibitors in african-americans who had both hypertension and type-2 diabetes this is an important study despite its small sample size and the fact that there were no cardiovascular outcomes it suggested implica Folsom can be used safely in this population african-americans are known to have an increase in hypertension and coma diabetes and in fact 80% of persons who have type 2 diabetes also have hypertension and this is even higher in the black population in the regard study a large southern cohort of over 30,000 persons only 30 percent of african-americans who had both diabetes and hypertension had their blood pressures controlled to less than 130 over 80 implica Fulton has been shown to be beneficial in the Emporer egg study nevertheless in the study which we just completed control of cardiovascular risks specifically diabetes glucose and blood pressure can be used in this particular population I'm dr. Keith C Ferdinand talking about diabetes in its relation to cardiovascular care

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