Re-purposing of diabetic drugs to treat cardiovascular disorders
Four new ESC guidelines were released at the ESC Congress. One, released in collaboration with the European Association for the Study of Diabetes (EASD), details the management and prevention of CVD in patients with diabetes or prediabetes. These recommendations come after recent positive findings from large outcome trials with new classes of diabetes drugs, which demonstrated improvements in cardiovascular health independent of metabolic outcomes. These glucose-lowering compounds include the sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. These guidelines also aim to reclassify cardiovascular risk in diabetic patients based on co-morbidities, with the plan to prevent cardiovascular disorder (CVD) initiation in those at high risk. These guidelines are timely given the global prevalence of diabetes is set to rise to more than 600 million people by the year 2045.
Other guidelines addressed acute pulmonary embolism, supraventricular tachycardia, chronic coronary syndromes, and dyslipidaemias. Aggressive targeting of low-density lipoprotein (LDL) cholesterol from <70 mg/dL to <55 mg/dL is now advocated in high-risk patients; as unequivocal evidence shows a causal effect of LDL in the development of atherosclerotic CVD. Lipid-lowering drugs such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, have shown success and can be prescribed in combination with statins to achieve these targets.
A need for greater funding in cardiovascular research?
Despite excellent increases in life expectancy, partly as a result of cardiovascular medicine, there was a consensus that “the war is not over” particularly in developing nations (Borja Ibanez). In a symposium presided over by Professor Valentin Fuster (Mount Sinai Hospital, USA), he implored delegates of the need to communicate that cardiovascular disease is “still the number one killer in the world and that more funding for CVDs research is urgently needed” (Fig. 1). One strong recommendation given to cardiologists was to form multi-disciplinary teams to research and deliver interventions, especially with endocrinologists treating type 2 diabetes (Michael Farkouh).
Digital health in cardiology
The Digital Health Area provided a space for all exciting new developments in cardiovascular technology (Fig. 2). In recent times, machine learning predicts deaths/ heart attacks better than clinical experts and/or physical measurements (Luis Eduardo Juarez-Orozco), wearable watches can perform electrocardiograms (Nicola Straiton), while eHealth virtual care helps patients reach blood pressure targets more effectively than standard care (Carl Lavie). As Professor Harry Hemingway (University College London, UK) stated, the challenge now is applying the power of large scale health data into clinically-meaningful discoveries that address health challenges and improve people’s lives.
This wonderfully well-organised ESC Congress was able to cater for more than 30,000 delegates from around the world. Services included practical-based tutorials (Fig. 3), breakfast networking events, and interactive ESC guideline sessions, facilitating the dialogue and integration of new clinical practice codes. The extensive material from ESC TV, online-accessible presentation videos and slides will ensure that cardiovascular health professionals can review content all the way up to 2020’s congress held once again in Amsterdam for the first time since 2013 (Fig. 4).