Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored

McMurray, J. J.V. , Gerstein, H. C., Holman, R. R. and Pfeffer, M. A. (2014) Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored. Lancet Diabetes and Endocrinology, 2(10), pp. 843-851. (doi:10.1016/S2213-8587(14)70031-2)

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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 glucose-lowering 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 glucose-lowering drugs of hospital admission for heart failure as a prespecified 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: McMurray, J. J.V., Gerstein, H. C., Holman, R. R., and Pfeffer, M. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Lancet Diabetes and Endocrinology
Publisher:Elsevier
ISSN:2213-8587
ISSN (Online):2213-8595

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