Treating Disease Mechanisms in Patients With Heart Failure and Diabetes Mellitus.

PURPOSE OF REVIEW: Diabetes and heart failure commonly coexist and portend worsened prognosis than either disease alone. We explore mechanisms that may serve as potential treatment targets and review the effects of various contemporary glucose-lowering agents on heart failure outcomes.

RECENT FINDINGS: Promising data has emerged on sodium-glucose cotransporter 2 (SLGT2) inhibitors as the first class of agents to improve cardiovascular mortality and heart failure outcomes in diabetic individuals both with and without established heart failure. Poor glycemic control is linked to worse heart failure outcomes; however, targeting glycemic control alone has not been sufficient. Furthermore, multiple commonly used antihyperglycemic agents may lead to adverse heart failure effects. SGLT2 inhibitors target multiple mechanisms implicated in diabetes and heart failure and may play a promising role in primary prevention of heart failure and in treatment of individuals with diabetes and established heart failure.