Author + information
- Venu Gopal Jonnalagadda, MS Pharm, PGDRA∗ (, )
- Eshvendar Reddy Kasala, MS Pharm, PhD and
- Chandra Shekhar Sriram, MS Pharm, PhD
- ↵∗Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, C/O NETES Institute of Technology & Science, NH-37, Shantipur, Parli Part, Mirza, Assam 781125, India
We have read the review paper “Distinct Myocardial Targets for Diabetes Therapy in Heart Failure With Preserved or Reduced Ejection Fraction” by Paulus et al. (1). The authors presented the distinct targets for diabetes therapy in heart failure (HF) with preserved or ejection fraction (1). Besides these findings, we would like to highlight a few observations with respect to this review article.
The authors represented that tight glycemic control did not have a potential beneficial effect on left ventricular diastolic dysfunction (1). In contrast, increased glucose levels causes increase the risk of HF in nondiabetic patients (2). In continuation, metformin has been graded as a first-line agent for the treatment of HF. However, many antihyperglycemic drugs have a potential risk of HF. Metformin was demonstrated to have a lower risk of HF as compared with other antihyperglycemic drugs (insulin, the sulfonylureas, and thiazolidinediones), but caution should be taken for its lactic acidosis concern (3).
Moreover, the authors presented that, dipeptidyl peptidase-4 inhibitors, glucagon like peptide-1 analogues, sodium glucose cotransporter-2 inhibitors, and gliflozins lower glycemia through blocked renal glucose absorption and enhanced glucosuria. However, only sodium glucose cotransporter-2 inhibitors act through this mechanism; the remaining drugs act through different pathways (4).
A recent article published by McMurray et al. (5) showed a beneficial effect of dipeptidyl peptidase-4 inhibitor in patients with HF and reduced left ventricular ejection fraction (i.e., <0.40) and increased in left ventricular volumes.
In a nutshell, HF is a common comorbid disorder of type 2 diabetes mellitus and little is known about its effects in patients on antihyperglycemic therapy. Hence, large-scale trials or observational studies should be undertaken to establish its potential benefits in a wider population. In the meantime, we should not forget our old soldier, namely, metformin, due to its widespread use and safety profile.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
- Paulus W.J.,
- Dal Canto E.
- Nielson C.,
- Lange T.
- Packer M.
- McMurray J.J.V.,
- Ponikowski P.,
- Bolli G.B.,
- et al.