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Heart failure: A cardiovascular outcome in diabetes that can no longer be ignored
McMurray, John J. V. Gerstein, Hertzel C. Holman, Rury R. Pfeffer, Marc A.
McMurray, John J. V.
Gerstein, Hertzel C.
Holman, Rury R.
Pfeffer, Marc A.
Abstract
In patients with type 1 or type 2 diabetes, glycaemic exposure assessed as HbA1c correlates strongly with risk of future microvascular and macrovascular complications. Improved glucose control substantially reduces the risk of microvascular complications and, with extended follow-up, modestly reduces the risk of atherosclerotic events. The lowering of HbA1c concentrations by newly developed glucose-lowering drugs (alone or when added to other glucoselowering drugs) has been used, until recently, as a surrogate measure of their potential to lower cardiovascular risk. This assumption is no longer acceptable, and now demonstration of cardiovascular safety has been mandated by regulatory authorities. A major concern, however, is the universal absence in any large-scale trials of new glucoselowering drugs of hospital admission for heart failure as a prespecifi ed component of the primary composite cardiovascular outcomes. This omission is important because hospital admission for heart failure is a common and prognostically important cardiovascular complication of diabetes. Moreover, it is the one cardiovascular outcome for which the risk has been shown unequivocally to be increased by some glucose-lowering therapies. As such, we believe that heart failure should be systematically evaluated in cardiovascular outcome trials of all new glucose-lowering drugs.
Keywords
Date
2014
Type
Journal article
Journal
The Lancet Diabetes & Endocrinology
Book
Volume
2
Issue
10
Page Range
843-851
Article Number
ACU Department
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Open Access Status
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Controlled