Heart of Steel

FDA: Liraglutide Prevents Heart Attacks, Strokes, and CV Deaths

It’s official as of Friday. Liraglutide (Victoza) is not only for treating type 2 diabetes and obesity. FDA now says it also effectively prevents heart attacks, strokes, and cardiovascular deaths. This new information applies to people taking it for diabetes who also have heart disease.

A Dramatic, Ongoing Shift in Diabetes Care

This news represents another important milestone in diabetes care. Not long ago, treating type 2 diabetes meant ignoring obesity for the most part. In fact, some of the mainstays of treatment actually caused weight gain.

It was perverse, really.

While doctors told patients with diabetes to keep their weight under control, they prescribed drugs like sulfonylureas and rosiglitazone (Avandia) that added to their weight problem. Too often, they prescribed insulin in a way that caused unnecessary weight gain.

And at the same time, the treatment goals focused narrowly on lab values – keeping blood sugar under control. Outcomes for major complications of diabetes – kidney disease, heart disease, stroke – were out of sight and out of mind. The impact of diabetes drugs on those end points was largely unproven.

Everything started changing when suspicions built around the safety of rosiglitazone. A high profile study in the New England Journal of Medicine linked rosiglitazone to an increased risk of heart attacks and death. A federal investigation of the drug’s maker, GlaxoSmithKline, ended with the company paying a $3 billion fine for withholding safety data.

As a result in 2008, FDA began requiring big cardiovascular studies for all new diabetes and obesity drugs.

In parallel, new diabetes drugs – like liraglutide – came along that helped with modest weight reductions, as well as controlling blood sugar. One of those drugs, empagliflozin (Jardiance), was the first to get an indication for preventing cardiovascular deaths late last year.

What Does It Mean for Obesity?

We are in the midst of a growing epidemic of type 2 diabetes. Three decades of dramatic rises in obesity set the stage for this epidemic.

But finally, healthcare providers are starting to take obesity into account as they treat type 2 diabetes. Obesity medicine specialists do everything possible to eliminate drugs that cause weight gain. Attention to preventing diabetes with smart obesity care is growing. Medicare is in the midst of implementing the Diabetes Prevention Program broadly. The focus of that program is evidence-based weight management.

And even though the new indication for liraglutide does not apply to its use in obesity, it certainly won’t hurt. For obesity, liraglutide (Saxenda) is already the most successful new treatment for obesity.

Better care for obesity lies ahead.

Click here and here to read more about the new indication for liraglutide. For the LEADER study, which provides the basis for this new indication, click here.

Heart of Steel, photograph © Liviu Ghemaru / flickr

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Month 28, 2017