Patients who manage type 2 diabetes with drugs that lower glucose or blood sugar may be at higher risk for heart failure.
This was the finding of a comprehensive analysis of clinical trials covering more than 95,000 patients reported in The Lancet Diabetes and Endocrinology. The study was also presented at the 64th Annual Scientific Session of the American College of Cardiology in San Diego, CA, earlier this week.
Heart failure has a major impact on the quality of life of patients and is a major driver of health care costs in the US.
The Centers for Disease Control and Prevention (CDC) estimate heart failure costs the nation $32 billion each year. This figure includes the cost of health care services, medications and missed days of work.
For the new study, the investigators searched libraries of published studies for large, randomized controlled trials of type 2 diabetes glucose-lowering drugs or strategies that assessed cardiovascular outcomes.
Fourteen trials involving a total of 95,502 participants matched their criteria. They pooled and analyzed the data to calculate the relative risks of heart failure posed by each of the type 2 diabetes medications or treatments.
14% increased risk of heart failure in patients on sugar-lowering drugs to manage diabetes
Lead investigator Dr. Jacob Udell, of the Peter Munk Cardiac Centre at the University Health Network (UHN) and the Women's College Hospital (WCH), both in Toronto, Canada, says they found:
- Breathlessness, tiredness and swollen ankles are the main symptoms of heart failure
- While it is a serious condition, it does not mean the heart has stopped beating
- About 5.1 million people in the US have heart failure.
"Patients randomized to new or more intensive blood sugar-lowering drugs or strategies to manage diabetes showed an overall 14% increased risk for heart failure."
He explains that the "increased risk was directly associated with the type of diabetes therapy that was chosen, with some drugs more likely to cause heart failure than others, compared with placebo or standard care."
Senior author Dr. Michael Farkouh, chair of the Peter Munk Centre of Excellence in Multinational Clinical Trials, adds:
"While some drugs showed an increased risk, other strategies tested, such as intensive weight loss to control blood sugar, showed a trend towards a lower risk for heart failure.
Overall, the results show that for every kilo of weight gain due to sugar-lowering diabetes treatment, there was an associated 7% higher risk of heart failure directly linked to that treatment.
The authors note that the relative increase in the risk of heart failure outweighed a 5% fall in heart attacks.
They also calculated that for around every 200 patients treated, there was one extra hospital admission for heart failure after an average follow-up of 4 years.
In the following video, Dr. Udell summarizes the findings and implications of their study for patients, doctors and researchers:
Dr. Barry Rubin, medical director of the Peter Munk Cardiac Centre at UHN, says:
"The results of this study could prove to be the catalyst for how diabetes patients at risk for heart disease are managed moving forward."
Medical News Today recently reported a new study that assesses the global economic impact of type 2 diabetes. The authors conclude that the US has the highest lifetime health care costs associated with type 2 diabetes. They calculate that the lifetime health care costs of the disease among Americans is $283,000, the highest among countries with similar average income levels.