P5272Concomitant heart failure (HF) and type 2 diabetes (T2D) - a deadly duo

Abstract

Background/Aims: Diabetes and heart failure (HF) are both global epidemics with tremendous costs on society with increased rates of HF hospitalizations and worsened prognosis when co‐existing, making it a significant “deadly duo”. The evidence for pharmacological treatment of HF in patients with type 2 diabetes mellitus (T2D) stems typically from either subgroup analyses of patients that were recruited to randomized controlled trials of HF interventions, usually in patients with reduced EF, or from subgroup analyses of HF patients recruited to cardiovascular (CV) outcome trials (CVOT) of glucose lowering agents involving patients with T2D. We explored the incremental effect on mortality/morbidity of co‐existing HF and T2D in these trials. Methods: This work summarizes the literature on interventions aiming to reduce the HF burden in T2DM and includes 7 HF trials of ACEi, digoxin, β blocker, ARB, If‐blocker, MRA, and ARNI involving 38600 patients, with or without prevalent diabetes, and 7 CVOTs in T2D involving 64209 patients, with or without prevalent HF. Results: In all HF trials, HF outcomes by prevalent diabetes were reported with an incremental risk of HF and death confessed by prevalent diabetes and a treatment effect similar to those without diabetes (Figure 1A). All T2D CVOTs reported on HF outcomes (Figure 1B) with heterogeneity between trials with one reporting benefits (empagliflozin) and two reporting increased risk (saxagliptin, pioglitazone). Conclusions: In vulnerable T2D patients with concomitant HF, guideline recommended HF drugs are effective. When choosing glucose lowering therapy, outcomes from available CVOTs should be considered. (Figure Presented).