Premium
Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology
Author(s) -
Seferović Petar M.,
Petrie Mark C.,
Filippatos Gerasimos S.,
Anker Stefan D.,
Rosano Giuseppe,
Bauersachs Johann,
Paulus Walter J.,
Komajda Michel,
Cosentino Francesco,
de Boer Rudolf A.,
Farmakis Dimitrios,
Doehner Wolfram,
Lambrinou Ekaterini,
Lopatin Yuri,
Piepoli Massimo F.,
Theodorakis Michael J.,
Wiggers Henrik,
Lekakis John,
Mebazaa Alexandre,
Mamas Mamas A.,
Tschöpe Carsten,
Hoes Arno W.,
Seferović Jelena P.,
Logue Jennifer,
McDonagh Theresa,
Riley Jillian P.,
Milinković Ivan,
Polovina Marija,
van Veldhuisen Dirk J.,
Lainscak Mitja,
Maggioni Aldo P.,
Ruschitzka Frank,
McMurray John J.V.
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1170
Subject(s) - medicine , empagliflozin , heart failure , pioglitazone , rosiglitazone , type 2 diabetes mellitus , cardiology , metformin , population , saxagliptin , coronary artery disease , type 2 diabetes , diabetes mellitus , canagliflozin , ejection fraction , intensive care medicine , insulin , endocrinology , sitagliptin , environmental health
The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30–40% of patients) and associated with a higher risk of HF hospitalization, all‐cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first‐line choice. Sulphonylureas and insulin have been the traditional second‐ and third‐line therapies although their safety in HF is equivocal. Neither glucagon‐like preptide‐1 (GLP‐1) receptor agonists, nor dipeptidyl peptidase‐4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium–glucose co‐transporter‐2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM.