Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology - PubMed (original) (raw)

Review

. 2018 May;20(5):853-872.

doi: 10.1002/ejhf.1170. Epub 2018 Mar 8.

Mark C Petrie 2, Gerasimos S Filippatos [ 3](#full-view-affiliation-3 "Department of Cardiology, National and Kapodistrian University of Athens Medical School, Athens University Hospital "Attikon", Athens, Greece."), Stefan D Anker 4, Giuseppe Rosano 5, Johann Bauersachs 6, Walter J Paulus 7, Michel Komajda 8, Francesco Cosentino 9, Rudolf A de Boer 10, Dimitrios Farmakis 2, Wolfram Doehner 11, Ekaterini Lambrinou 12, Yuri Lopatin 13, Massimo F Piepoli 14, Michael J Theodorakis 15, Henrik Wiggers 16, John Lekakis 2, Alexandre Mebazaa 17, Mamas A Mamas 18, Carsten Tschöpe 19, Arno W Hoes 20, Jelena P Seferović 21, Jennifer Logue 22, Theresa McDonagh 23, Jillian P Riley 24, Ivan Milinković 1, Marija Polovina 1, Dirk J van Veldhuisen 25, Mitja Lainscak 26, Aldo P Maggioni 27, Frank Ruschitzka 28, John J V McMurray 29

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Review

Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology

Petar M Seferović et al. Eur J Heart Fail. 2018 May.

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Abstract

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.

Keywords: Glucose-lowering agents; Heart failure; Heart failure hospitalization; Heart failure treatment; Type 2 diabetes mellitus.

© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.

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