Hypoglycaemic Agents in Patients with Heart Failure

International Cardiovascular Forum Journal

Giuseppe MC Rosano¹  Petar Seferović² 

[1] Centre for Clinical & Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy;President, Heart Failure Association of the ESC and Professor of Internal Medicine/Cardiology at Belgrade University School of Medicine, and the Heart Failure Department, University Medical Center Belgrade, Belgrade, Serbia.;

关键词: heart failure;    diabetes mellitus;    therapy;    sglt2 inhibitors;   

DOI  :  https://doi.org/10.17987/icfj.v18i0.623

来源: DOAJ

【 摘 要 】

Impaired glucose metabolism and diabetes are both very common in HF, and associated with worse functional status and prognosis. More lenient rather than strict glycaemic control is advised in patients with HF. In patients with diabetes and HF glycaemic control should be implemented gradually and moderately, giving preference to those drugs that have been shown to be safe and effective. SGLT2 inhibitors improve CV outcomes and reduce the risk of hospitalisations for heart failure, and are as a result the preferred glucose-lowering agents in T2DM patients at risk for, or with, established HF. Metformin is considered safe in HF with diabetes and is a preferred agent for glycaemic control in this setting. Sulfonylurea treatment seems to be associated with a higher risk of HF hospitalisation and is not indicated in patients with heart failure. GLP-1 receptor agonists have been proven to reduce macrovascular end points in patients with type II diabetes, however, they seem at most ineffective in patients with HF with reduced ejection fraction, and are not therefore the preferred agents in this patient population. DPP-4 inhibitors (gliptins) have only a limited effect on glucose control and no benefit on cardiovascular events and therefore do have compelling arguments for use in HF patients with type 2 diabetes.

【 授权许可】

Unknown