Treatment of heart failure in diabetic patients

Czech version

Authors: Jaromír Hradec
Authors‘ workplace: III. interní klinika 1. LF UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Vnitř Lék 2014; 60(4): 310-315
Category: 60th Birthday - prof. MUDr. Petr Widimský, DrSc., FESC, FACC

Overview

Heart failure occurs in diabetic patients and vice versa, among patients with heart failure is high prevalence of diabetes mellitus. Treatment of heart failure in diabetics is not substantially different from the treatment of heart failure in non-diabetic patients. It is based on ACE-inhibitors, beta-blockers and mineralocorticoid receptor blockers. In advanced heart failure the treatment with various devices reaches importance, for example biventricular pacing for cardiac resynchronization. Recently, it has been discussed the question of long-term cardiovascular safety of hypoglycaemic drugs. Older anti-diabetic agents such as insulin, metformin, and sulfonylurea are considered to be cardiovascular safe. However, rosiglitazone from thiazolidinedione class increases incidence of cardiovascular events, resulting in cancellation of its registration in Europe and its considerably limited use in the United States. Therefore, cardiovascular safety is tested very carefully in clinical trials in new anti-diabetic agents that affect incretin system. Recently, saxagliptin has shown to increase incidence of heart failure in diabetic patients.

Key words:
cardiovascular risk – diabetes mellitus – heart failure – peroral antidiabetics

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