CASE-J 10 confirms reduction in new-onset diabetes risk among high-risk patients on candesartan
Candesartan reduced the risk of new-onset diabetes among Japanese patients with hypertension and high cardiovascular risk after a 10-year follow-up period, confirming the findings of the CASE-J* trial, according to a study presented at APSC 2017.
“Candesartan treatment for hypertension may have some potential benefits on new-onset diabetes compared with amlodipine. These findings corroborate the results of the CASE-J and the CASE-J extension by longer follow-up,” said Dr Liu Jinliang from Kyoto University Hospital, Kyoto, Japan, who called for further research to confirm the findings in other populations.
In the 10-year follow-up study (CASE-J 10), researchers compared data of 645 patients on candesartan with 668 patients on amlodipine from the CASE-J cohort (mean age 63 years, 48.2 and 56.1 percent female, respectively), analysing study endpoints using the CASE-J and CASE-J extension cohorts (n=4,703). Blood pressure was well-controlled in patients on either treatment.
The incidence of first cardiovascular event (a composite of cardiac, cerebrovascular, renal, and vascular events, and sudden death) was comparable between patients on candesartan and amlodipine (14.7 percent vs 14.8 percent; hazard ratio [HR], 0.94, 95 percent confidence interval [CI], 0.70–1.27; p=0.703). The risk of new-onset diabetes was significantly lower among patients on candesartan compared with amlodipine (4.7 percent vs 6.4 percent; HR, 0.71, 95 percent CI, 0.52–0.97; p=0.029). [APSC 2017, Late Breaking Trial 5]
The results reflected those of CASE-J (n=4,728) which demonstrated no significant difference in the incidence of cardiovascular events between patients on candesartan and amlodipine after 3.2 years of follow up (HR, 1.01, 95 percent CI, 0.79–1.28; p=0.969), though there was a 36 percent relative risk reduction (p=0.03) of new-onset diabetes among patients on candesartan. [Expert Rev Cardiovasc Ther 2008;6:1195-1201]
The results of 2,232 patients who were followed up for another 3 years in the CASE-J extension trial were similar, where cardiovascular event incidence was comparable between patients on candesartan and amlodipine (HR, 0.95, 95 percent CI, 0.77–1.18; p=0.650), while new-onset diabetes risk was lower among patients on candesartan (HR, 0.71, 95 percent CI, 0.51–1.00; p=0.0495). [Hypertens Res 2011;34:1295-1301]
The most notable benefit of candesartan on new-onset diabetes and mortality in CASE-J was among patients with the highest BMI, which suggests that candesartan may be more applicable for patients with hypertension and a more metabolic phenotype, said Professor Carolyn Lam from the National Heart Centre Singapore in her commentary.
She also did not discount a potential negative impact of some antidiabetic agents on cardiovascular outcomes, as well as the low rate of new-onset diabetes and cardiovascular events as a confounding factor.