Clinical Summary

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

Pavankumar Kamat, BS Pharm, MSc

Takeaway

Metformin, sulphonylureas, and insulin had comparable beneficial effects in patients with type 2 diabetes mellitus (T2DM) and ischaemic heart failure (HF).

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

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.

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).

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.