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The effects of antidiabetic agents on heart failure

M Wijnen1, E J J Duschek2,3, H Boom2,4

  • 1Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands. mark_wijnen@live.nl.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|June 7, 2021
PubMed

Insights

Sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduce heart failure risk in patients with and without diabetes. These antidiabetic agents offer benefits beyond standard heart failure treatments.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Heart failure affects 250,000 people in the Netherlands, with one-third having type 2 diabetes.
  • The cardiovascular effects of antidiabetic agents were previously unclear.
  • Thiazolidinediones prompted cardiovascular outcome trials for new glucose-lowering drugs due to observed risks.

Purpose of the Study:

  • To review the effects of antidiabetic agents on heart failure.
  • To highlight the impact of newer antidiabetic classes on heart failure outcomes.

Main Methods:

  • Review of clinical trials and available data on antidiabetic agents and heart failure.
  • Analysis of cardiovascular outcome trials for dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and SGLT2 inhibitors.

Main Results:

  • Dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists showed no benefit for heart failure in type 2 diabetes patients.
  • Sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduced the risk of incident and worsening heart failure.
  • Favorable effects of SGLT2 inhibitors were observed in non-diabetic patients with heart failure with reduced ejection fraction, reducing hospitalizations.

Conclusions:

  • SGLT2 inhibitors represent a significant advancement in managing heart failure, offering benefits regardless of diabetes status.
  • These agents improve outcomes on top of existing heart failure therapies, including sacubitril/valsartan.
  • SGLT2 inhibitors may also benefit patients with heart failure with preserved ejection fraction.

Keywords:
Diabetes mellitus type 2Heart failurePharmacology

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