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Assessment of Heart Failure in Diabetes Cardiovascular Outcomes Trials: Is What We Are Currently Capturing Adequate?

Christa D Bowes1, Lillian F Lien1, Javed Butler2

  • 1Division of Endocrinology, University of Mississippi, Jackson, MS, USA.

Current Diabetes Reports
|May 26, 2019
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 inhibitors show heart failure benefits in type 2 diabetes trials. However, more data are needed for glucagon-like peptide 1 receptor agonists, and some dipeptidyl peptidase-4 inhibitors increased heart failure hospitalizations.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Novel glucose-lowering agents require cardiovascular outcome trials (CVOTs) per FDA guidance since 2008.
  • Thirteen agents have undergone dedicated CVOTs, with heart failure hospitalization data collected inconsistently.
  • Understanding heart failure outcomes is crucial for managing type 2 diabetes mellitus (T2DM).

Purpose of the Study:

  • To review and summarize heart failure outcome data from CVOTs of novel glucose-lowering agents.
  • To assess the safety and efficacy of these agents concerning heart failure in T2DM patients.

Main Methods:

  • Systematic review of published cardiovascular safety trials for glucose-lowering drugs.
  • Analysis of reported heart failure hospitalization rates and related adverse events.
  • Evaluation of data from trials involving sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and dipeptidyl peptidase-4 inhibitors.

Main Results:

  • Sodium-glucose cotransporter-2 inhibitors demonstrate promising benefits for heart failure outcomes.
  • Glucagon-like peptide 1 receptor agonists lack sufficient data to confirm heart failure safety.
  • Saxagliptin and alogliptin (dipeptidyl peptidase-4 inhibitors) showed increased heart failure hospitalization rates, leading to a class warning.

Conclusions:

  • Evidence supports sodium-glucose cotransporter-2 inhibitors' role in managing heart failure in T2DM.
  • Further research is needed for glucagon-like peptide 1 receptor agonists' cardiovascular safety profile.
  • Standardized definitions and reporting of heart failure events in future trials are recommended.
Keywords:
Cardiovascular outcomesDiabetes mellitusHeart failure

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