Heart Failure: The Most Important, Preventable, and Treatable Cardiovascular Complication of Type 2 Diabetes

Packer, Milton

doi:10.2337/dci17-0052

Cited by 87 publications

(68 citation statements)

References 24 publications

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“…Both obesity and type 2 diabetes are important risk factors for the development of heart failure (HF) with preserved ejection fraction (HFpEF). [1][2][3][4] Of patients with established HFpEF, 70-80% are obese, and nearly half have type 2 diabetes. 5,6 However, the diagnosis of HFpEF can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Packer

2019

European J of Heart Fail

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Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk‐to‐benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post‐ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.

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Section: Introductionmentioning

confidence: 99%

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Packer

2019

European J of Heart Fail

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“…Additionally, inhibitors of the renin-angiotensin system, which are primarily antihypertensive agents, are also known to prevent the onset of HF and progression of diabetic nephropathy while reducing CV risks and hHF [24]. Valsartan in combination with sacubitril (PARADIGM-HF) has shown significantly low rate of hHF ( [25].…”

Section: Effect Of Antidiabetes Drugs On Cardiovascular Outcomesmentioning

confidence: 99%

Heart failure outcomes in patients with type 2 diabetes mellitus: findings from the cardiovascular outcome trials of antidiabetes agents

Anker¹

2020

Diabetes mellitus

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Type 2 diabetes mellitus (T2DM) is a recognised risk factor for several cardiovascular (CV) conditions including heart failure (HF). Findings that reflect CV risk associated with T2DM medications have led to regulatory requirement of conducting CV outcome trials (CVOTs) for new antidiabetes drugs. Over the years, several CVOTs using different glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors and sodium-glucose co-transporter-2 inhibitors have reported neutral or improved CV risks or hospitalisation for HF. However, these studies included only a small proportion of the patients with baseline HF thus limiting the available evidence. Ongoing trials such as EMPEROR programme and DAPA-HF in large patient populations with chronic HF could potentially broaden the use of these drugs beyond their conventional therapeutic indication.

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“…Furthermore, besides hyperglycemia other risk factors are operative in the underlying cause of HF in T2D, which may explain the underlying myocardial alterations . HF is a disease that is increasingly recognized to cause significant morbidity and mortality in T2D patients, especially in those with established microvascular complications . Elucidating the role of intensive control on CV outcomes is even more important now than ever given the striking association between T2D and diastolic HF, or HF with preserved ejection fraction (HFpEF).…”

Section: Management Of Hyperglycemia In Patients With Type 2 Diabetesmentioning

confidence: 99%

Sodium glucose cotransporter (SGLT)‐2 inhibitors: Do we need them for glucose‐lowering, for cardiorenal protection or both?

Scholtes

Baar

Bjornstad

et al. 2019

Diabetes Obesity Metabolism

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Sodium glucose cotransporter (SGLT)‐2 inhibitors are the newest addition to our treatment armamentarium for the management of hyperglycemia in type 2 diabetes. Glucose‐lowering per se reduces the risk of microvascular complications, but not the risk of cardiovascular disease, including heart failure and cardiovascular mortality. Also, even when embedded in optimal cardiovascular prevention, a large residual risk remains with respect to progression of diabetic kidney disease. SGLT‐2 inhibitors lower blood glucose levels by inducing glucosuria. Through various proposed mechanisms, among which diuretic and natriuretic effects, SGLT‐2 inhibitors decrease heart failure hospitalization, reduce cardiovascular mortality, and mitigate progression of diabetic kidney disease. In this perspective, we will discuss the glucose‐lowering and other protective effects of SGLT‐2 inhibitors on the cardiorenal axis, both in primary and secondary prevention. By comparing the glycemic and pleiotropic effects of these agents to other glucose‐lowering drugs, we will address questions around whether SGLT‐2 inhibitors should be considered primarily as glucose‐lowering agents, cardiorenal drugs or both.

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Heart Failure: The Most Important, Preventable, and Treatable Cardiovascular Complication of Type 2 Diabetes

Cited by 87 publications

References 24 publications

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Heart failure outcomes in patients with type 2 diabetes mellitus: findings from the cardiovascular outcome trials of antidiabetes agents

Sodium glucose cotransporter (SGLT)‐2 inhibitors: Do we need them for glucose‐lowering, for cardiorenal protection or both?

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