Diabetes Medications and Heart Failure

Recognizing the Risk

The diabetes pandemic is currently among the most challenging noncommunicable disease threats to public health. It is estimated that 382 million people worldwide have diabetes mellitus, and the majority will likely die of cardiovascular disease. Diabetes mellitus is an independent risk factor for atherosclerotic cardiovascular disease and heart failure, with a 5-fold increased risk of heart failure in women with

diabetes mellitus and a 2.4-fold increased risk in men.1–3 In patients with diabetes mellitus, the prevalence of heart failure is between 10% and 22%, 4 times higher than that of the general population.2 The degree of glycemic control in patients

with diabetes mellitus has been demonstrated to be associated with the risk of atherosclerotic cardiovascular disease and new-onset heart failure.1,4 It has been a widely held belief that lowering hemoglobin A1c levels with glucose-lowering

medications in patients with diabetes mellitus would result in clinical benefits, including a reduction in atherosclerotic cardiovascular events. Lowering of the hemoglobin A1c levels by glucose-lowering medications in patients with diabetes mellitus has been used as a surrogate measure of their benefit, including the potential to reduce cardiovascular risk, by clinicians, guideline writing groups, and regulators.

Diabetes Medications and Heart Failure

Recognizing the Risk

The diabetes pandemic is currently among the most challenging noncommunicable disease threats to public health. It is estimated that 382 million people worldwide have diabetes mellitus, and the majority will likely die of cardiovascular disease. Diabetes mellitus is an independent risk factor for atherosclerotic cardiovascular disease and heart failure, with a 5-fold increased risk of heart failure in women with

diabetes mellitus and a 2.4-fold increased risk in men.1–3 In patients with diabetes mellitus, the prevalence of heart failure is between 10% and 22%, 4 times higher than that of the general population.2 The degree of glycemic control in patients

with diabetes mellitus has been demonstrated to be associated with the risk of atherosclerotic cardiovascular disease and new-onset heart failure.1,4 It has been a widely held belief that lowering hemoglobin A1c levels with glucose-lowering

medications in patients with diabetes mellitus would result in clinical benefits, including a reduction in atherosclerotic cardiovascular events. Lowering of the hemoglobin A1c levels by glucose-lowering medications in patients with diabetes mellitus has been used as a surrogate measure of their benefit, including the potential to reduce cardiovascular risk, by clinicians, guideline writing groups, and regulators.

Even a commonly used drug like glibenclamide was once suspected of accelerating atherosclerosis

A comprehensive study examining clinical trials of more than 95,000 patients has found that glucose or sugar-lowering medications prescribed to patients with diabetes may pose an increased risk for the development of heart failure in these patients.

http://www.uhn.ca/corporate/News/PressReleases/Pages/medications_used_to_treat_diabetes_may_trigger_heart_failure.aspx

Dear Colleague,

Your question is important and not easy to answer, beause several factors play a determined role in heart failure development in DM patients. First the diabetes itself wich is a cause of heart failure or at least enhances other factors influencing this affection such as atherosclerosis, muscle glycogene depletion and others. Second: drugs used for arterial pressure decrease such as beta-blockers for instance,but also others, may favorize both heart failure and glucide metabolism disorders when administrated in primary prevention or inadequately. Third, the very antidiabetjc drugs, at least some of them, may have a similar negative effect on the heart function either in general, or in peculiar conditions.

So, as often in mecicine,  each case deserves special consideration for a judicious choice of the adequate medications, taking into account literature and results of great studies on the topic. And you alone may do this choice and ne responsible for it...

Good luck and success

V.Coulic

Dear Colleague,

Your question is important and not easy to answer, beause several factors play a determined role in heart failure development in DM patients. First the diabetes itself wich is a cause of heart failure or at least enhances other factors influencing this affection such as atherosclerosis, muscle glycogene depletion and others. Second: drugs used for arterial pressure decrease such as beta-blockers for instance,but also others, may favorize both heart failure and glucide metabolism disorders when administrated in primary prevention or inadequately. Third, the very antidiabetjc drugs, at least some of them, may have a similar negative effect on the heart function either in general, or in peculiar conditions.

So, as often in mecicine,  each case deserves special consideration for a judicious choice of the adequate medications, taking into account literature and results of great studies on the topic. And you alone may do this choice and ne responsible for it...

Good luck and success

V.Coulic

A common diabetes medication in the US, Actos, has been linked to edema and congestive heart failure. This relationship has been known since its introduction.

TZD are contraoindicated, both Pioglitazone and Rosiglitazone are associated with hearth failure. Some DPP4i have been also associated with hearth failure, but this is not clear. Empagliflozin (and possibly the other SGLT2i) may reduce the risk of hospitalization due to hearth failure but should not be used in combination with loop diuretics, and a recent metanalysis have highlighted a possible risk for ischemic stroke. Insulin is always the safer option.

Two components in Type 2 diabetes medications may up heart failure risk

The Food and Drug Administration is warning healthcare professionals to consider discontinuing the use of Type 2 diabetes medications containing saxagliptin and alogliptin, due to a higher risk of heart failure, especially in patients with existing heart or kidney disease.

The FDA said patients should consult their doctors before discontinuing the medication and report heart failure symptoms:  shortness of breath; trouble breathing; tiredness, weakness, or fatigue; weight gain; and swelling in their ankles, feet, legs, or stomach.

The FDA also said in its warning on Tuesday that doctors should consider prescribing other drugs for patients whose blood sugar is not well-controlled.  It will require warning labels for drugs containing the two components.

Following are common brand names of medications containing saxagliptin and alogliptin:

• Onglyza (saxagliptin)

• Kombiglyze XR (saxagliptin and metformin extended release)

• Nesina (alogliptin)

• Kazano (alogliptin and metformin)

• Oseni (alogliptin and pioglitazone)

Warnings resulted from two large research trials showing higher rates of heart failure hospitalizations for patients taking medications with saxagliptin or alogliptin: 3.5 percent of saxagliptin patients compared to 2.8 percent on a placebo; and 3.9 percent of alogliptin patients versus 3.3 percent taking placebo.

Patients were at higher risk if they had a history of heart failure or kidney problems.

http://news.heart.org/two-components-in-type-2-diabetes-medications-may-up-heart-failure-risk/