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New study links diabetes treatments to increased risk of heart failure

For diabetes patients, or patients at risk of diabetes, medications or methods that lower glucose (blood-sugar) levels may also increase risk of heart failure, a new study shows.

The heart failure risks were significantly higher for some types of glucose-lowering treatments compared to others. In contrast, treatment to lower glucose levels was also linked to a small decrease in the risk of heart attack. Glucose-lowering treatments are used in patients with diabetes to decrease the level of glucose (sugar) in the blood. These treatments include different types of medications as well as other approaches, such as intensive weight loss.

The large study, led by Dr. Jacob Udell, a cardiologist at Women’s College Hospital and assistant professor of medicine at the University of Toronto, was a meta-analysis (research that examines the collected results of several previous studies). It included 14 clinical trials that looked at different approaches to lowering blood sugar in patients with Type 2 diabetes, or who were at risk of developing diabetes.

A total of 95,502 patients were included in the analysis. About four per cent of the study participants developed heart failure, and almost 10 per cent had a major cardiovascular event (such as a heart attack, an ischemic stroke or a blocked coronary artery). Heart failure occurs when the heart muscle is weakened or damaged and cannot pump blood efficiently. A heart attack occurs when the blood supply to the heart is blocked, starving the heart muscle of oxygen.

The researchers found that people who were using a glucose-lowering strategy were 14 per cent more likely to develop heart failure compared to those who were receiving either standard care or a placebo.

Some diabetes treatments affected heart failure risk more than others. Patients taking PPAR agonist medications (peroxisome proliferator-activated receptor agonists) had a 42 per cent increased relative risk of heart failure, while patients taking DPP4 inhibitors (dipeptidyl peptidase-4 inhibitors) had a 25 per cent increase in relative risk. Other approaches – insulin, target-based glycemic control, and intensive weight loss – did not have a significant effect on heart failure risk.

Glucose-lowering treatments were also linked to an eight per cent drop in the relative risk of heart attack.

Weight gain was also linked to an increased risk of heart failure. For every kilogram of weight gain from glucose-lowering, the relative risk of heart failure increased by seven per cent. Weight gain differed in patients using different approaches to glucose lowering: patients taking PPAR agonists gained an average of 3.6 kilograms; patients using intensive glycemic control gained an average of 2.2 kilograms, and patients on insulin gained an average of 2.1 kilograms. Those on DPP4 inhibitors lost an average of 0.36 kilograms, and those using intensive weight loss lost an average of four kilograms.

The researchers noted that these results show the importance of balancing risks of heart failure with those of cardiovascular events such as heart attack when deciding on an approach to blood-sugar treatment in patients with diabetes.

The study was published in The Lancet Diabetes and Endocrinology in March, 2015.

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  • A publication of:
  • Women's College Hospital