Cardiovascular Outcomes of Antidiabetic Treatments in Patients with T2DM and Ischaemic HF

Pavankumar Kamat

Disclosures

March 30, 2022

Takeaway

Why This Matters

  • There is uncertainty regarding optimal diabetes control strategies in patients with HF following myocardial infarction.

Study Design

  • The prospective cohort study included data on 1172 patients with T2DM and incident HF of ischaemic aetiology from the Clinical Practice Research Datalink, UK, linked to hospital admission and mortality data (1998-2010).

  • Primary outcome: composite of cardiovascular (CV) death and HF hospitalisations.

  • Secondary outcome: individual components of the primary outcome and all-cause mortality.

  • Funding: National Institute for Health Research Biomedical Research Centre at University College London Hospitals.

Key Results

  • During the median follow-up of 2.53 years, 596 (50.9%) of 1172 patients had a composite of CV death and HF hospitalisations.

  • Metformin (adjusted HR [aHR] 0.50; 95% CI 0.42 to 0.59), sulphonylureas (aHR 0.66; 95% CI 0.55 to 0.80), and insulin (aHR 0.53; 95% CI 0.43 to 0.65) were associated with a lower risk of composite of CV death and HF hospitalisations (P<0.001 for all).

  • Similarly, metformin (aHR 0.43; 95% CI 0.35 to 0.52), sulphonylureas (aHR 0.57; 95% CI 0.46 to 0.70), and insulin (aHR 0.34; 95% CI 0.27 to 0.43) were linked to a lower risk of all-cause mortality (P<0.001 for all).

Limitations

  • Observational design.

  • Possible risk of unmeasured confounding.

  • Newer treatments for T2DM such as sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide-1 agonists, and dipeptidyl peptidase-4 inhibitors were not assessed.

Godec TR, Bromage DI, Pujades-Rodriguez M, Cannatà A, Gonzalez-Izquierdo A, Denaxas S, Hemingway H, Shah AM, Yellon DM, McDonagh TA. Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure. ESC Heart Fail. 2022 Mar 23 [Epub ahead of print]. doi: 10.1002/ehf2.13910. PMID: 35322592 View abstract.

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