Heart Failure and Diabetes: Clinical significance and epidemiology of this two-way association.

People with type 2 diabetes (T2DM) and those with pre-diabetes have an increased risk of heart failure (HF). Longer duration of T2DM correlates with a greater risk of HF, but HF is also seen in patients with recent onset diabetes. Insulin resistance is more likely to be present in patients with HF. The risk of HF persists even in the face of standard of care preventive treatments for atherosclerotic cardiovascular disease (ASCVD). HF is commonly the presenting symptom of cardiovascular disease (CVD) in people with diabetes and HF is the most expensive complication of diabetes due to the high cost of hospitalizations. Recently hospitalization for HF has been included in cardiovascular outcome studies (CVOT) including for medications that are used to treat T2DM which has led to new therapies for all HF patients. In addition, these CVOT trials have shown that many drugs, utilized in the therapy of diabetes, are either neutral or detrimental in the HF patient and should be used with caution in patients with existing HF or those at high risk for HF. Most recently the SGLT-2 receptor blockers have shown efficacy in both HFrEF and HFpEF. The only other oral or injectable diabetes agent shown to improve outcomes in both is metformin. This article is protected by copyright. All rights reserved.