The impact of diabetes on heart failure development: The cardio-renal-metabolic connection

Area of Science:

• Cardiology
• Nephrology
• Endocrinology
• Pharmacology

Background:

• Type 2 diabetes (T2D) frequently coexists with heart failure (HF) and chronic kidney disease (CKD).
• These conditions (T2D, HF, CKD) interact synergistically, increasing risks for cardiac and renal events.
• Evaluating risks of renal worsening in HF patients and HF in CKD patients is crucial for preventive strategies.

Purpose of the Study:

• To review recent clinical trials on HF and CKD in T2D.
• To assess the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in preventing HF and renal decline.
• To highlight the role of SGLT2is in managing cardio-renal-metabolic interactions in T2D.

Main Methods:

• Analysis of recent cardiovascular and renal clinical trials in T2D.
• Evaluation of evidence for SGLT2 inhibitors in HF and CKD populations.
• Comparison of treatment benefits in specific patient subgroups versus the general T2D population.

Main Results:

• SGLT2 inhibitors demonstrate significant benefits in patients with heart failure with reduced ejection fraction (HFrEF), improving cardiovascular prognosis and HF-related outcomes.
• SGLT2 inhibitors are effective in slowing renal failure progression and reducing hospitalizations for HF and cardiovascular death in CKD patients.
• The number of patients needed to treat with SGLT2 inhibitors to prevent events is lower in patients with coexisting HF/CKD compared to high-risk T2D patients.

Conclusions:

• SGLT2 inhibitors are a primary therapeutic choice for patients with T2D, HFrEF, and CKD, offering substantial cardio-renal protection.
• GLP1-receptor agonists serve as a viable alternative for patients intolerant or contraindicated to SGLT2 inhibitors.
• Integrated care involving diabetologists, nephrologists, and cardiologists is essential for managing the complex cardio-renal-metabolic interactions in T2D.