Choice of antidiabetic agents in heart failure
Diabetes mellitus is a well-known risk factor for cardiovascular disease. Up to 35% of patients with heart failure have diabetes mellitus. Some studies have suggested the existence of diabetic cardiomyopathy, a unique entity which is independent of other cardiac risk factors. The choice of antidiabe...
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| Format: | Conference or Workshop Item |
| Language: | English |
| Published: |
2017
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| Online Access: | http://irep.iium.edu.my/58563/ http://irep.iium.edu.my/58563/1/Antidiabetic%20in%20heart%20failure.pdf |
| Summary: | Diabetes mellitus is a well-known risk factor for cardiovascular disease. Up to 35% of patients with heart failure have diabetes mellitus. Some studies have suggested the existence of diabetic cardiomyopathy, a unique entity which is independent of other cardiac risk factors. The choice of antidiabetics in this population should be taken into careful consideration as current evidences indicate that certain anti-diabetic agents may influence heart failure outcome.
There were previous concern that metformin may increase the risk of lactic acidosis in heart failure and renal impairment, however, clinical studies have shown the contrary. In fact, the use of metformin in patient with heart failure was associated with reduction in mortality with no excess admission for metabolic acidosis. On the other hand, thiazolidinediones (TZD) has been associated with fluid retention and increased risk of heart failure. Interestingly, the new class of anti-diabetic drug dipeptidyl peptidase 4 (DPP-4) inhibitors showed conflicting evidences. While saxagliptin in the SAVOR-TIMI 53 increases the risk of hospitalization due to heart failure, alogliptin, sitagliptin and vildagliptin in their cardiovascular safety trials showed neutral results. Two meta-analyses on DPP-4 inhibitors trials showed contradictory findings on heart failure. Despite benefits in heart failure demonstrated in animal studies, glucagon-like-peptide 1 (GLP-1) use did not reduce the admission for heart failure in clinical trials. Finally, the latest addition to the oral antidiabetic family, the sodium-glucose transporter 2 (SGLT-2) inhibitors, empaglifozin in the EMPA-REG trial has been proven to lower death from cardiovascular causes, hospitalization for heart failure and all-cause mortality. This was, perhaps, the most exciting result on anti-diabetics in the past decade.
In conclusion, a large proportion of patients with heart failure are diabetics. While older anti-diabetics were associated with increased risk of worsening heart failure in particularly TZD, newer anti-diabetic such as SGLT-2 inhibitors are associated with positive outcome in patients with heart failure. |
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