Vascular legacy: HOPE ADVANCEs to EMPA-REG and LEADER: A Surprising similarity

Abstract

Recently reported cardiovascular outcome studies on empagliflozin (EMPA-REG) and liraglutide (LEADER) have spurred interest in this field of diabetology. This commentary compares and contrasts these studies with two equally important outcome trials conducted using blood pressure lowering agents. A comparison with MICROHOPE (using ramipril) and ADVANCE (using perindopril + indapamide) blood pressure arms throws up interesting facts. The degree of blood pressure lowering, dissociation between cardiovascular and cerebrovascular benefits, and discordance between renal and retinal outcomes are surprisingly similar in these trials, conducted using disparate molecules. The time taken to achieve such benefits is similar for all drugs except empagliflozin. Such discussion helps inform rational and evidence-based choice of therapy and forms the framework for future research.

Keywords: ACE inhibitors; GLP1 receptor agonists; SGLT2 inhibitors; cardio-cerebral dissociation; cardiovascular outcome trial; cerebro-coronary dissociation; diabetes; diuretics; fixed dose combination; reno-retinal dissociation; vascular legacy; vascular memory.