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The influence of anti-hyperglycemic drug therapy on cardiovascular and heart failure outcomes in patients with type 2 diabetes mellitus

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Abstract

Patients with type 2 diabetes mellitus (DM) are at a substantially increased risk of heart failure (HF) and HF mortality. Despite the lack of evidence that tight glycemic control reduces the incidence of cardiovascular (CV) events, a growing body of evidence suggests that the choice of glucose-lowering agents may influence outcomes including HF. Thiazolidinediones are associated with a significant risk of HF. For metformin, sulphonylureas and insulin, little data is available to indicate the impact on HF. The glucagon-like peptide-1 (GLP-1) agonists, liraglutide and semaglutide, have been shown to reduce major CV events, but did not affect rates of hospitalization for HF. Clinical trials have demonstrated diverse effects of Dipeptidyl peptidase-4 (DPP-4) inhibitors on HF; saxagliptin showed an increased risk of HF admissions, alogliptin was associated with higher rates of new HF admissions, while sitagliptin had a neutral effect. The sodium-glucose cotransporter 2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have been recently shown to reduce the incidence of HF and cardiovascular mortality in patients with and without a history of HF. This review will summarize key findings of the impact of glucose-lowering agents on CV safety and HF-associated outcomes, present available data on the underlying mechanisms for the benefits of the SGLT2 inhibitors on HF, and discuss strategies to improve outcomes in patients with DM and high CV risk.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Gonda 5 S, Rochester, MN, 55905, USA

    Rabea Asleh & Sudhir S. Kushwaha

  2. Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel

    Mohammad Sheikh-Ahmad

  3. Department of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Alexandros Briasoulis

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  1. Rabea Asleh
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  2. Mohammad Sheikh-Ahmad
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  3. Alexandros Briasoulis
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Correspondence to Rabea Asleh.

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RA, AB, and SSK declare that they have no conflict of interest. MSA has received consulting fees or a speaker honorarium from Eli Lilly, Sanofi, AstraZeneca, Novo Nordisk, Boehringer Ingelheim, Novartis, and MSD.

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Asleh, R., Sheikh-Ahmad, M., Briasoulis, A. et al. The influence of anti-hyperglycemic drug therapy on cardiovascular and heart failure outcomes in patients with type 2 diabetes mellitus. Heart Fail Rev 23, 445–459 (2018). https://doi.org/10.1007/s10741-017-9666-8

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