Author + information
- Received November 27, 2017
- Revision received May 6, 2018
- Accepted May 6, 2018
- Published online September 24, 2018.
- Abhinav Sharma, MDa,b,c,∗ (, )
- Lauren B. Cooper, MDd,
- Mona Fiuzat, PhDa,
- Robert J. Mentz, MDa,
- João Pedro Ferreira, MD, PhDe,f,
- Javed Butler, MD, MPH, MBAg,
- David Fitchett, MDh,
- Alan Charles Moses, MDi,
- Christopher O’Connor, MDa,d and
- Faiez Zannad, MD, PhDe
- aDuke Clinical Research Institute, Duke University, Durham, North Carolina
- bDivision of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- cDivision of Cardiology, Stanford University, Palo Alto, California
- dInova Heart and Vascular Institute, Falls Church, Virginia
- eCentre d’Investigations Cliniques Plurithématique 1433, Institut national de la santé et de la recherche médicale, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
- fCardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
- gDivision of Cardiology, Stony Brook University, Stony Brook, New York
- hDivision of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- iNovo Nordisk A/S, Soborg, Denmark
- ↵∗Address for correspondence:
Dr. Abhinav Sharma, Duke Clinical Research Institute, 2400 Pratt Street, Durham, North Carolina 27705.
There is increasing recognition of the relationship between diabetes and heart failure (HF). Comorbid diabetes is associated with worse outcomes in patients with HF, and death from HF forms a large burden of mortality among patients with diabetes and atherosclerotic cardiovascular disease. However, there is evidence of harm relating to the risk of HF outcomes from several antihyperglycemic therapies. The absence of well-powered randomized controlled studies has resulted in significant treatment variations in the glycemic management in patients with coexisting diabetes and HF. However, there is emerging evidence from recent clinical trials suggesting that sodium-glucose–co-transporter-2 inhibitors may be used as a therapy to improve HF outcomes. In order to understand the current state of knowledge, we reviewed the evolving evidence of antihyperglycemic therapies and present strategies to optimize these therapies in patients with diabetes and HF. This analysis is based on discussions among scientists, clinical trialists, industry sponsors, and regulatory representatives who attended the 12th Global Cardiovascular Clinical Trialists Forum, Washington, DC, December 1 to 3, 2016.
Dr. Sharma has received support from Bayer-Canadian Cardiovascular Society, Alberta Innovates Health Solution, Bristol-Myers Squibb-Pfizer, Roche Diagnostics, and Takeda. Dr. Mentz has received support from U.S. National Institutes of Health (NIH) grants U10HL110312 and R01AG045551-01A1 and from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Luitpold, Medtronic, Merck, Novartis, Otsuka, and ResMed; has received honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Merck, Novartis, ResMed, and Thoratec/St. Jude; and has served as an advisory board member for Amgen, Luitpold, Merck, and Boehringer Ingelheim. Dr. Butler has received support from NIH, European Union, and Patient Centered Outcomes Research Initiative (PCORI); and has consulted for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, Janssen, Luitpold, Medtronic, Novartis, Relypsa, Vifor, and ZS Pharma. Dr. Moses is an employee of Novo Nordisk; has received continuing medical education from Boehringer; has consulted for Boehringer, Lilly, Amgen, Merck, Sanofi, Novartis, and AstraZeneca; is a steering committee member for the EMPA REG Outcome trial; and has been on the data monitoring and safety board for the SUSTAIN 6 and PIONEER 6 studies. Dr. Zannad has received honoraria from Takeda Development Center. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
John R. Teerlink, MD, served as Guest Editor for this paper.
- Received November 27, 2017.
- Revision received May 6, 2018.
- Accepted May 6, 2018.
- Central Illustration
- Recognition of HF Hospitalization as an Important Event in AntiHyperglycemic Drug Trials
- Risks and Benefits of AntiHyperglycemic Therapies in Patients With Diabetes and HF
- Optimizing Therapies in Patients With Diabetes and HF
- Future Directions