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Diabetes Drugs Differ on HF; School-Based Obesity Program Flop; Plaque Type in ACS

Diabetes Drugs Differ on HF; School-Based Obesity Program Flop; Plaque Type in ACS

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Diabetes drug classes are not all the same for heart failure risk, affirmed a nationwide sample from a large U.S. commercial insurance database reported in BMJ.

The SGLT-2 drug canagliflozin (Invokana) carried lower risk of heart failure admission — 30% compared with a DPP-4 inhibitor, 39% versus a GLP-1 receptor antagonist, and 49% compared with a sulfonylurea. A composite endpoint of acute myocardial infarction, ischemic stroke, or hemorrhagic stroke admission numerically favored canagliflozin as well, but without statistical significance against the other classes.

“Our results suggest a potential beneficial effect of canagliflozin … on heart failure hospital stays in routine care similar to what was noted in exploratory endpoint analyses in the CANVAS trial for canagliflozin, and in the EMPA-REG OUTCOME trial for empagliflozin [Jardiance]; thus, our study responds to the need of confirmatory evidence raised by these exploratory data, in line with the discussion at a recent meeting of the Endocrinologic and Metabolic Drugs Advisory Committee of the [FDA],” the researchers wrote.

Obesity Prevention at School

A school-based obesity intervention program for 5- to 6-year-olds in one area of England failed to impact BMI compared with standard health education in the WAVES study reported in BMJ.

Mean BMI-z scores were not significantly different at 15 or 30 months after the multi-faceted, year-long intervention. Nor were any secondary outcomes improved, including total daily energy intake, levels of physical activity, and systolic blood pressure.

“Our research, combined with wider evidence, suggests that schools cannot lead on the childhood obesity prevention agenda,” lead author Peymané Adab, MD, of the University of Birmingham in England, said in a statement.

“Whilst school is an important setting for influencing children’s health behaviour, and delivery of knowledge and skills to support healthy lifestyles is one of their mandatory functions, widespread policy change and broader influences from the family, community, media, and the food industry is also needed,” added co-author Miranda Pallan, PhD, also of the University of Birmingham.

See the full MedPage Today story here.

Plaque Type in ACS

Plaque causing acute coronary syndrome (ACS) isn’t all the same, researchers reaffirmed in a study of plaque characteristics published in JAMA Cardiology.

Close examination of plaque in 51 men with ACS showed that events caused by “culprit plaque erosion had a smaller number of nonculprit plaques and the lower levels of panvascular instability, affirming that distinct pathophysiologic mechanisms operate in plaque erosion and plaque rupture.”

While more study is needed, the researchers suggested that their “observations support the notion that different treatment strategies may apply to these two types of patients.”

Afib in Asia

Researchers in Taiwan documented a rising burden of atrial fibrillation (Afib) there, with a prevalence rate that increased from 0.46% in 2000 to 1.07% in 2011 and is projected to climb to 4.01% by the year 2050 as the population ages.

For ethnically-Chinese adults 20 and older, the lifetime risk of Afib was projected at one in seven. As expected, the complications associated with Afib are expected to rise as well, researchers noted in the paper in CHEST for their nationwide cohort study.

Separately, the American Heart Association published a consensus document in Hypertension on hypertension management for Asian patients.

In Other News

Stroke featured a panel of studies into how stroke risk, treatment and outcomes differ for women and men.


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