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Title: | European Society of Cardiology/Heart FailureAssociation position paper on the role andsafety of new glucose-lowering drugs inpatients with heart failure | Authors: | Seferovic, Petar M. Coats, Andrew J. S. Ponikowski, Piotr Filippatos, Gerasimos Huelsmann, Martin Jhund, Pardeep S. Polovina, Marija M. Komajda, Michel Seferovic, Jelena Sari, Ibrahim Cosentino, Francesco Ambrosio, Giuseppe Metra, Marco Piepoli, Massimo Chioncel, Ovidiu Lund, Lars H. Thum, Thomas De Boer, Rudolf A. MULLENS, Wilfried Lopatin, Yuri Volterrani, Maurizio Hill, Loreena Bauersachs, Johann Lyon, Alexander Petrie, Mark C. Anker, Stefan Rosano, Giuseppe M. C. |
Issue Date: | 2020 | Publisher: | WILEY | Source: | EUROPEAN JOURNAL OF HEART FAILURE, 22 (2), p. 196-213 | Abstract: | Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and associated with considerable morbidity and mortality. Significant advances have recently occurred in the treatment of T2DM, with evidence of several new glucose-lowering medications showing either neutral or beneficial cardiovascular effects. However, some of these agents have safety characteristics with strong practical implications in HF [i.e. dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter type 2 (SGLT-2) inhibitors]. Regarding safety of DPP-4 inhibitors, saxagliptin is not recommended in HF because of a greater risk of HF hospitalisation. There is no compelling evidence of excess HF risk with the other DPP-4 inhibitors. GLP-1 RAs have an overall neutral effect on HF outcomes. However, a signal of harm suggested in two small trials of liraglutide in patients with reduced ejection fraction indicates that their role remains to be defined in established HF. SGLT-2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) have shown a consistent reduction in the risk of HF hospitalisation regardless of baseline cardiovascular risk or history of HF. Accordingly, SGLT-2 inhibitors could be recommended to prevent HF hospitalisation in patients with T2DM and established cardiovascular disease or with multiple risk factors. The recently completed trial with dapagliflozin has shown a significant reduction in cardiovascular mortality and HF events in patients with HF and reduced ejection fraction, with or without T2DM. Several ongoing trials will assess whether the results observed with dapagliflozin could be extended to other SGLT-2 inhibitors in the treatment of HF, with either preserved or reduced ejection fraction, regardless of the presence of T2DM. This position paper aims to summarise relevant clinical trial evidence concerning the role and safety of new glucose-lowering therapies in patients with HF. | Notes: | Seferovic, PM (reprint author), Univ Belgrade, Fac Med, 8 Koste Todorovica, Belgrade 11000, Serbia.; Seferovic, PM (reprint author), Univ Belgrade, Med Ctr, Heart Failure Ctr, 8 Koste Todorovica, Belgrade 11000, Serbia. seferovic.petar@gmail.com |
Other: | Seferovic, PM (reprint author), Univ Belgrade, Fac Med, 8 Koste Todorovica, Belgrade 11000, Serbia, Univ Belgrade, Med Ctr, Heart Failure Ctr, 8 Koste Todorovica, Belgrade 11000, Serbia. seferovic.petar@gmail.com | Keywords: | Heart failure;Type 2 diabetes mellitus;Cardiovascular risk;Hospitalisation;Sodium-glucose co-transporter type 2 inhibitor;Glucagon-like peptide-1 receptor agonist;Dipeptidyl peptidase-4 inhibitor;Clinical trial | Document URI: | http://hdl.handle.net/1942/30584 | ISSN: | 1388-9842 | e-ISSN: | 1879-0844 | DOI: | 10.1002/ejhf.1673 | ISI #: | WOS:000501377400001 | Rights: | 2019 European Society of Cardiology | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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File | Description | Size | Format | |
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European J of Heart Fail - 2019 - Seferovi - European Society of Cardiology Heart Failure Association position paper on the.pdf | Published version | 7.47 MB | Adobe PDF | View/Open |
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