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Type 2 diabetes mellitus and heart failure

Christine K Choy1, Jo E Rodgers, Jean M Nappi

  • 1Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA.

Pharmacotherapy
|January 30, 2008
PubMed

Insights

Diabetes and heart failure significantly increase mortality risk. Metformin may reduce risk, while thiazolidinediones increase heart failure risk. Standard heart failure therapies are generally beneficial for diabetic patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetes mellitus and heart failure are increasingly prevalent comorbidities.
  • Patients with both conditions face a poorer prognosis and higher mortality risk (1.5-2 fold).

Purpose of the Study:

  • To examine the relationship between diabetes and heart failure.
  • To assess the impact of antidiabetic drugs on heart failure development.
  • To evaluate heart failure therapies in diabetic patients.

Main Methods:

  • Review of randomized controlled trials and retrospective analyses.
  • Analysis of subgroup data from landmark clinical trials.

Main Results:

  • Insulin and sulfonylureas show no significant effect on new-onset heart failure.
  • Metformin may offer a modest risk reduction for heart failure.
  • Thiazolidinediones increase heart failure risk, especially with insulin.
  • ACE inhibitors, ARBs, beta-blockers, and aldosterone antagonists are beneficial in diabetic patients with heart failure.

Conclusions:

  • Metformin's role in established heart failure requires further study.
  • Thiazolidinediones should be used cautiously in heart failure patients with diabetes.
  • Standard heart failure treatments are largely effective and recommended for diabetic patients.
  • Future studies need robust diabetes cohorts for subgroup analysis.

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