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Heart failure in diabetes: effects of anti-hyperglycaemic drug therapy

Richard E Gilbert1, Henry Krum2

  • 1Division of Endocrinology, St Michael's Hospital, University of Toronto, On, Canada.

Lancet (London, England)
|May 27, 2015
PubMed

Insights

Diabetic patients face high heart failure risks. While some heart failure drugs are effective, the impact of glucose-lowering treatments on heart failure risk requires careful consideration, especially with newer agents.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetes mellitus significantly elevates the risk of developing and succumbing to heart failure.
  • Established heart failure therapies demonstrate comparable efficacy in diabetic and non-diabetic individuals.
  • The cardiovascular effects of intensive glycemic control and various antihyperglycemic agents remain less understood.

Purpose of the Study:

  • To review the current understanding of the relationship between glycemic control and heart failure risk in diabetic patients.
  • To evaluate the impact of different classes of antihyperglycemic drugs on heart failure risk.
  • To discuss the cardiovascular safety profile of emerging glucose-lowering medications.

Main Methods:

  • Review of existing literature on diabetes, glycemic control, and heart failure.
  • Analysis of clinical trial data regarding antihyperglycemic agents and cardiovascular outcomes.
  • Focus on specific drug classes, including dipeptidylpeptidase-4 (DPP4) inhibitors.

Main Results:

  • Certain antihyperglycemic agents, such as insulin and thiazolidinediones, have known associations with fluid retention or increased heart failure risk.
  • A notable finding includes an increased risk of hospitalization for heart failure with the DPP4 inhibitor saxagliptin compared to placebo.
  • Established heart failure medications are generally effective in diabetic patients.

Conclusions:

  • The choice of antihyperglycemic therapy in diabetic patients requires careful consideration of potential cardiovascular risks, particularly heart failure.
  • Further research is needed to fully elucidate the cardiovascular safety of various glucose-lowering drugs.
  • Individualized treatment strategies are essential to manage both glycemic control and heart failure risk in diabetes.

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