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Title: Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology
Authors: Seferović, Petar M. 
Petrie, MarkC 
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. 
Keywords: Glucose-lowering agents;Heart failure;Heart failure hospitalization;Heart failure treatment;Type 2 diabetes mellitus
Category: Clinical Medicine
Field: Medical and Health Sciences
Issue Date: May-2018
Publisher: John Wiley and Sons Ltd
Source: European Journal of Heart Failure, 2018, Volume 20, Issue 5, Pages 853-872
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.
ISSN: 13889842
Rights: © 2018 The Authors. European Journal of Heart Failure
Type: Article
Appears in Collections:Άρθρα/Articles

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