- Heart Failure Association of the European Society of Cardiology position statement summarizes epidemiology, mechanisms, and treatment options for patients with type 2 diabetes (T2D) and heart failure (HF), and possible HF prevention with T2D medications.
Why this matters
- Coexistence of HF and T2D is common, affecting clinical management/prognosis.
- Comorbid T2D and HF confers increased risks for HF hospitalization and rehospitalization and increased all-cause and cardiovascular mortality, independent of HF etiology or phenotype.
- HF treatment with medications and devices (eg, implantable cardioverter-defibrillator, cardiac resynchronization therapy-defibrillator) is similarly effective in patients with and without T2D.
- No randomized trials have assessed safety of older T2D drugs such as insulin and sulfonylureas in patients with comorbid HF.
- Some glucose-lowering drugs, including rosiglitazone (Avandia), pioglitazone (Actos), and saxagliptin (Onglyza), appear to increase HF hospitalization risk in patients with T2D without baseline HF and are contraindicated in patients with T2D with prior HF or risk for HF.
- In large cardiovascular outcomes trials, glucagon-like peptide-1 receptor agonists and a dipeptidyl peptidase-4 inhibitor, sitagliptin (Januvia), have shown a neutral effect on HF hospitalization risk.
- In trials, the sodium–glucose cotransporter-2 inhibitors empagliflozin (Jardiance) and canagliflozin (eg, Invokana) significantly reduced HF hospitalization risk in patients with T2D.