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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Main Author:	Shahar, Mohammad Arif
Format:	Conference or Workshop Item
Language:	English
Published:	2017
Subjects:	R Medicine (General) RC Internal medicine
Online Access:	http://irep.iium.edu.my/58563/ http://irep.iium.edu.my/58563/1/Antidiabetic%20in%20heart%20failure.pdf

id	iium-58563
recordtype	eprints
spelling	iium-585632017-09-28T01:59:41Z http://irep.iium.edu.my/58563/ Choice of antidiabetic agents in heart failure Shahar, Mohammad Arif R Medicine (General) RC Internal medicine 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. 2017 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/58563/1/Antidiabetic%20in%20heart%20failure.pdf Shahar, Mohammad Arif (2017) Choice of antidiabetic agents in heart failure. In: 8th National Diabetes Conference 2017, 28th-30th July 2017, Subang USJ, Selangor. (Unpublished)
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General) RC Internal medicine
spellingShingle	R Medicine (General) RC Internal medicine Shahar, Mohammad Arif Choice of antidiabetic agents in heart failure
description	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.
format	Conference or Workshop Item
author	Shahar, Mohammad Arif
author_facet	Shahar, Mohammad Arif
author_sort	Shahar, Mohammad Arif
title	Choice of antidiabetic agents in heart failure
title_short	Choice of antidiabetic agents in heart failure
title_full	Choice of antidiabetic agents in heart failure
title_fullStr	Choice of antidiabetic agents in heart failure
title_full_unstemmed	Choice of antidiabetic agents in heart failure
title_sort	choice of antidiabetic agents in heart failure
publishDate	2017
url	http://irep.iium.edu.my/58563/ http://irep.iium.edu.my/58563/1/Antidiabetic%20in%20heart%20failure.pdf
first_indexed	2023-09-18T21:22:50Z
last_indexed	2023-09-18T21:22:50Z
_version_	1777411995985772544

Choice of antidiabetic agents in heart failure

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