Glifozins & Cardioprotection: Another Myth in the Making...!!!

Written by Meguid El Nahas on Friday, 21 July 2017. Posted in OLA Blog

Glifozins & Cardioprotection: Another Myth in the Making...!!!
N Engl J Med. 2017 Jun 12. doi: 10.1056/NEJMoa1611925. [Epub ahead of print]

Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes.

 The Myth:

The administration of SGLT2 (Sodium-Glucose coTransporter2) inhibitors improve cardiovascular outcomes in T2DM at high CVD risk. in CANVAS 2 such studeis were combined and concluded that the composite primary outcome of  death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke was improved by the administration of these agents. Renal outcomes also positive. Not the first time such a claim has been made. A beneficial effect that is claimed to be a class effect of all SGLT2 inhibitors.

Comments:

Once more the Pharmaceutical industry takes gulible doctors who cannot critically read a publication for a marketing ride...

As what is evident from this study is:

1. that acting as potent diuretics these drugs have an effect only on heart failure/reduction of oedema and related hospitalisation.

2. These agents have no effect on MACEs such as Myocardial infraction or strokes...

3. This is where "Composite endpoints" make them sound beneficial; whilst they are ONLY to fluid retention/heart failuire as they are potent diuretics...

4. These beneficial effects are most likely to be directly due to a significant reduction in both systolic and diastolic blood pressure; a reduction o BP of 3-4mmHg has been known for half a century to be protective against the progression of CKD in people with diabetes mellitus (Mogensen, 1976...). https://www.ncbi.nlm.nih.gov/pubmed/85044

5. THESE STUDIES DID NOT, INTENTIONALLY, COMPARE THESE SGLT2i WITH DIURETICS SUCH AS CHLORTHALIDONE OR INDAPAMIDE ALSO KNOWN TO REDUCE CVD IN DM: WHY? Because they would not have shown any therapeutic advantage...

So once more the PHARMACEUTICAL INDUSTRY wants doctors to beleive that new agents, that are potentially dangerous (more limbs amputations and fractures [likely to be due to hypotensive falls], AKI), are better than the best available therapy of diuretics...that is cheaper and as effective!

In fact, when it comes to reduction of MACEs (Major Adverse Cardiovascular Events) in people with T1 and T2DM, diuretics are as good as any other anti-hyeprtensive agent....Beta blockers, ACE inhibitors, CCB, etc...what matters in BP reduction as in this study...

https://www.ncbi.nlm.nih.gov/pubmed/27870655

IT IS HIGH TIME DOCTORS WAKE UP TO THE FACT THAT THEY ARE SOLD DANGEROUS AND COSTLY NEW AGENTS UNDER FALSE PRETENSE!

 

 

Meguid El Nahas

Professor Meguid El Nahas PhD, FRCP

Chief Editor, OLA Director

Professor El Nahas was born in Cairo, Egypt and undertook his undergraduate medical education in...

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