Type 2 diabetes mellitus and heart failure

Czech version

Authors: Aleš Linhart; prof. MUDr. Jan Bělohlávek, Ph.D.
Authors‘ workplace: II. interní klinika kardiologie a angiologie 1. LF UK a VFN v Praze
Published in: Vnitř Lék 2016; 62(7-8): 592-597
Category: Reviews

Overview

Type 2 diabetes mellitus is associated with a substantial increase in the risk of development of heart failure. The mechanisms causing this complication are complex and include coronary heart disease, myocardial changes induced by hypertension, increased aortic stiffness, arrhythmias, renal failure and last but not least by direct metabolic alterations causing diabetic cardiomyopathy. The heart failure could be induced by several drugs used for diabetes therapy. This review debates the current evidence of harms and benefits of diabetes treatment related to heart failure in the light of results of recent randomized trials. An increased risk of heart failure was reported with sulphonylureas, glizatones and some DPP4 inhibitors. In contrast a considerable risk reduction was demonstrated in the EMPA-REG OUTCOME trial using empagliflozin.

Key words:
aortic stiffness – arrhythmias – coronary heart disease – diabetes treatment – diabetic cardiomyopathy – hypertension – type 2 diabetes mellitus

Sources

1. Sarwar N, Gao P, Seshasai SR et al. [The Emerging Risk Factors Collaboration]. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375(9733): 2215–2222. Erratum in Lancet 2010; 376(9745): 958. Hillage, H L [corrected to Hillege, H L].

2. Nichols GA, Hillier TA, Erbey JR et al. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care 2001; 24(9): 1614–1619.

3. [Meta-analysis Global Group in Chronic Heart Failure (MAGGIC)]. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J 2012; 33(14): 1750–1757.

4. Owan TE, Hodge DO, Herges RM et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355(3): 251–259.

5. NaitoR, Kasai T. Coronary artery disease in type 2 diabetes mellitus: Recent treatment strategies and future perspectives. Word J Cardiol 2015; 7(3): 119–124.

6. Ehl NF, Kühne M, Brinkert M et al. Diabetes reduces left ventricular ejection fraction-irrespective of presence and extent of coronary artery disease. Eur J Endocrinol 2011; 165(6): 945–951.

7. Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis 2015; 238(2): 370–379.

8. Aksnes TA, Schmieder RE, Kjeldsen SE et al. Impact of new-onset diabetes mellitus on development of atrial fibrillation and heart failure in high-risk hypertension (from the VALUE Trial). Am J Cardiol 2008; 101(5): 634–638.

9. Ball J, Carrington MJ, McMurray JJ et al. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol 2013; 167(5): 1807–1824.

10. Eurich DT, McAlister FA, Blackburn DF et al. Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review. BMJ 2007; 335(7618): 497.

11. Poornima IG, Parikh P, Shannon RP. Diabetic cardiomyopathy: the search for a unifying hypothesis. Circ Res 2006; 98(5): 596–605.

12. Boudina S, Abel ED. Diabetic cardiomyopathy revisited. Circulation 2007; 115(25): 3213–3223.

13. Maisch B, Alter P, Pankuweit S. Diabetic cardiomyopathy – fact or fiction? Herz 2011; 36(2): 102–115.

14. Tenenbaum A, Motro M, Fisman EZ et al. Functional class in patients with heart failure is associated with the development of diabetes. Am J Med 2003; 114(4): 271–275.

15. MacDonald MR, Petrie MC, Hawkins NM et al. Diabetes, left ventricular systolic dysfunction, and chronic heart failure. Eur Heart J 2008; 29(10): 1224–1240.

16. Gerstein HC, Miller ME, Byington RP et al. [The Action to Control Cardiovascular Risk in Diabetes Study Group]. Effects of Intensive Glucose Lowering in Type 2 Diabetes. N Engl J Med 2008; 358(24): 2545–2559.

17. Patel A, MacMahon S, Chalmers J et al. [The ADVANCE Collaborative Group]. Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2008; 358(24): 2560–2572.

18. Rodney A, Hayward MD, Peter D et al. [VADT Investigators]. Follow-up of Glycemic Control and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2015; 372(23): 2197–2206.

19. Varas-Lorenzo C, Margulis AV, Pladevall M et al. The risk of heart failure associated with the use of noninsulin blood glucose-lowering drugs: systematic review and meta-analysis of published observational studies. BMC Cardiovasc Disord 2014; 14: 129. Dostupné z DOI: <http://dx.doi.org/10.1186/1471–2261–14–129>.

20. Eurich DT, Weir DL, Majumdar SR et al. Comparative safety and effectiveness of metformin in patients with diabetes mellitus and heart failure: systematic review of observational studies involving 34,000 patients. Circ Heart Fail 2013; 6(3): 395–402.

21. Erdmann E, Charbonnel B, Wilcox RG et al. [PROactive Investigators]. Pioglitazone use and heart failure in patients with type 2 diabetes and preexisting cardiovascular disease: data from the PROactive study (PROactive 08). Diabetes Care 2007; 30(11): 2773–2778.

22. Komajda M, McMurray JJ, Beck-Nielsen H et al. Heart failure events with rosiglitazone in type 2 diabetes: data from the RECORD clinical trial. Eur Heart J 2010; 31(7): 824–831.

23. Son JW, Kim S. Dipeptidyl Peptidase 4 Inhibitors and the Risk of Cardiovascular Disease in Patients with Type 2 Diabetes: A Tale of Three Studies. Diabetes Metab J 2015; 39(5): 373–383.

24. Scirica BM, Bhatt DL, Braunwald E et al. [SAVOR-TIMI 53 Steering Committee and Investigators]. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013; 369(14): 1317–1326.

25. White WB, Cannon CP, Heller SR et al. [EXAMINE Investigators]. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013; 369(14): 1327–1335.

26. Green JB, Bethel MA, Armstrong PW et al. [TECOS Study Group]. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med 2015; 373: 232–242.

27. McMurray J. Effect of vildagliptin on left ventricular function in patients with type 2 diabetes and congestive heart failure. Paper presented at: Heart Failure Congress 2013; May 25–28, 2013; Lisbon, Portugal.

28. Hippisley-Cox J, Coupland C. Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care. BMJ 2016; 354: i3477. Dostupné z DOI: <http://dx.doi.org/10.1136/bmj.i3477>.

29. Zinman B, WannerC, Lachin JM et al. [EMPA-REG OUTCOME Investigators]. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373(22): 2117–2128.

30. Wanner C, Inzucchi SE, Lachin JM et al. [EMPA-REG OUTCOME Investigators]. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med 2016; 375(4): 323–334.

31. Sattar N, McLAren J, Kristensen SL et al. SGLT2 Inhibition and cardiovascular events: why did EMPA-REG Outcomes surprise and what were the likely mechanisms? Diabetologia 2016; 59(7): 1333–1339.

32. Sonesson C, Johansson PA, Johnsson E et al. Cardiovascular effects of dapagliflozin in patients with type 2 diabetes and different risk categories: a meta-analysis. Cardiovasc Diabetol 2016; 15: 37. Dostupné z DOI: <http://dx.doi.org/10.1186/s12933–016–0356-y>.

33. Gerstein HC, Bosch J, Dagenais GR et al. [ORIGIN Trial Investigators]. Basal Insulin and Cardiovascular and Other Outcomes in Dysglycemia. N Engl J Med 2012; 367(4): 319–328.

34. Marso SP, Daniels GH, Brown-Frandsen K et al. [LEADER Steering Committee on behalf of the LEADER Trial Investigators]. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375(4): 311–322.

35. Ponikowski P, Voors AA, Anker SD et al. [Authors/Task Force Members; Document Reviewers]. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016 May 20. pii: ehw128. Dostupné z DOI: <http://dx.doi.org/10.1002/ejhf.592>.

36. Low Wang CC, Hess CN. Clinical Update: Cardiovascular Disease in Diabetes Mellitus Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus – Mechanisms, Management, and Clinical Considerations. Circulation 2016; 133(24): 2459–2502.