Diabetes Medications and Heart Failure: Recognizing the Risk
The diabetes pandemic is currently among the most challenging non-communicable disease threats to public health. It is estimated that 382 million people worldwide have diabetes and the majority will likely die from cardiovascular disease. Diabetes is an independent risk factor for atherosclerotic cardiovascular disease as well as heart failure, with a 5-fold increased risk of heart failure in women with diabetes and a 2.4-fold increased risk in men.1-3 In patients with diabetes, the prevalence of heart failure is between 10 to 22%, 4 times higher than that of the general population.2 The degree of glycemic control in patients with diabetes 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 HbA1c levels with glucose-lowering medications in patients with diabetes would result in clinical benefits, including the reduction of atherosclerotic cardiovascular events. Lowering of the HbA1c 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.5
- Received August 22, 2014.
- Accepted August 29, 2014.