CME Breakfast Symposium · Friday, May 4, 2018 · 7:10 – 8:25am

Management of T2DM Patients with Diabetic Kidney Disease: Effects of SGLT2 Inhibitors and GLP-1 Receptor Agonists on Disease Progression

Faculty: Matthew R. Weir, MD (Chair); Yehuda Handelsman, MD; Lance Sloan, MD

Kidney disease has been recognized as a complication of type 2 diabetes mellitus (T2DM) since the 1950s, developing in approximately 35% of patients with T2DM and affecting as many as 50% of patients with diabetes of more than 20 years’ duration. The prevalence of diabetic kidney disease (DKD) in the United States increased from 1988 to 2008 in proportion to the prevalence of diabetes. Among adults with diabetes, the prevalence of DKD has remained stable despite increased use of antihyperglycemic agents and renin-angiotensin-aldosterone system (RAAS) inhibitors.

Newer glucose-lowering agents appear to have glucose-independent effects on diabetic nephropathy and its progression. Recently published analyses of secondary objectives of three key studies, EMPA-REG, CANVAS-R, and LEADER, that assessed cardiovascular outcomes of SGLT2 inhibitors and a GLP-1 receptor agonist (RA) respectively, show positive effects on the development and progression of DKD.

This symposium will provide an overview of the renal effects of antiglycemic agents, particularly GLP-1 RAs and SGLT2 inhibitors. Experts will identify patients who are at the greatest risk for DKD, discuss the underlying physiology of DKD, provide an overview of the mechanisms of action of SGLT2 inhibitors and GLP-1 RAs in relation to renal physiology, and how to effectively manage patients with T2DM and DKD based on the benefits and risks of SGLT2 inhibitors and GLP-1 RAs.

Learning Objectives
After completing this activity, the participant should be better able to:

• Describe the relationship between T2DM, hypertension, and cardiorenal syndrome
• Review the most current T2DM algorithms and guidelines for the individualized treatment of complex patients, specifically those with DKD
• Summarize the mode of action and effects of GLP-1 RAs and SGLT-2 inhibitors on renal physiology in patients with T2DM and DKD
• Develop management plans for T2DM patients that consider the recently discovered renal effects of SGLT2 inhibitors and GLP-1 RAs

Supported by educational grants from Janssen Pharmaceuticals, Inc., administered by Janssen Scientific Affairs, LLC. and by Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA, LLC.

CME Breakfast Symposium · Saturday, May 5, 2018 · 7:40 – 8:55am

Identifying, Diagnosing and Managing Iron Deficiency in Patients with Heart Failure to Improve Outcomes and Quality of Life

Faculty: Clyde W. Yancy, MD (Chair); Biykem Bozkurt, MD; Gurusher Panjrath, MD

Iron deficiency (ID) affects up to one-third of the world's population and is particularly common in elderly individuals and those with certain chronic diseases such as chronic kidney disease, and congestive heart failure. Many of those affected are unaware of ID and cannot recognize its symptoms. For patients with heart failure (HF), ID is an independent predictor of outcomes and a major contributor to exercise intolerance. At least half of all patients with HF have comorbid ID; yet, the condition is under-recognized and untreated in most patients.

In this symposium, experts will provide participants with data from recent and ongoing trials of iron repletion in patients with HF to highlight the importance of diagnosis and proper management of this common comorbidity. Recent updates to established HF treatment guidelines that emphasize ID recognition and treatment will also be addressed. Additionally, the program will educate clinicians on the differences in oral versus intravenous iron formulations.

Learning Objectives
After completing this activity, the participant should be better able to:

• Describe the prevalence of iron deficiency (ID) in heart failure (HF) and its impact on patient outcomes and quality of life
• Identify the symptoms of ID using appropriate markers in HF patients in order to diagnose ID
• Discuss the updated ACC/AHA/HFSA and ESC recommended guidelines for the management of iron deficiency in patients with HF
• Review evidence from major clinical trials assessing the efficacy and safety of iron supplementation in HF patients to improve patient outcomes and reduce HF hospitalizations

Supported by an educational grant from American Regent.

CME Lunch Symposium · Saturday, May 5, 2018 · 12:50 – 2:05pm

Updates in Inflammation and Secondary CVD Prevention

Faculty: Christie M. Ballantyne, MD (Chair); Brendan M. Everett, MD; Ishwarlal Jialal, MD, PhD

Healthcare professionals agree on aggressive therapy for secondary prevention of CVD with statins, the cornerstone of therapy; however, recent focus has been given to the role of inflammation in the initiation and progression of atherosclerosis, the main cause of CVD, and as a treatment target for patients at risk. Observational evidence and results from clinical trials with statins have demonstrated that a reduction in inflammatory biomarkers, e.g., C-reactive protein (CRP), is associated with a reduction in cardiovascular events. A recent clinical trial has affirmed the hypothesis that reducing vascular inflammation in the absence of concomitant lipid lowering reduces the rates of cardiovascular events and demonstrated a 15% reduction in cardiovascular events compared to placebo.

During this symposium, Brendan M. Everett, MD and Ishwarlal Jialal, MD, PhD will provide an overview of the role of inflammation in the pathogenesis of atherosclerosis and atherothrombotic events and residual inflammatory risks in patients with CVD. The expert faculty will focus on the role of biomarkers in assessing secondary CVD risk and review the most recent clinical trial data from the completed CANTOS study and the ongoing CIRT trial. The session will conclude with an interactive patient case moderated by Christie M. Ballantyne, MD to demonstrate a patient at risk for secondary CVD and how managing inflammation may potentially reduce that risk. Participants will also be given the opportunity to pose questions and interact with the expert faculty during this time to enhance their knowledge and clinical practice.

Learning Objectives
After completing this activity, the participant should be better able to:

• Explain the role of inflammation in the underlying pathogenesis of the development and progression of atherosclerosis
• Identify the role of inflammatory biomarkers in the assessment of secondary CVD risk
• Review the results from clinical trials for emerging non-statin therapies targeting inflammation for the secondary prevention of CVD

Supported by an educational grant from Novartis Pharmaceuticals Corporation.