Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure
Abstract Aim The optimal strategy for diabetes control in patients with heart failure (HF) following myocardial infarction (MI) remains unknown. Metformin, a guideline‐recommended therapy for patients with chronic HF and type 2 diabetes mellitus (T2DM), is associated with reduced mortality and HF ho...
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13910 |
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| author | Thomas R. Godec Daniel I. Bromage Mar Pujades‐Rodriguez Antonio Cannatà Arturo Gonzalez‐Izquierdo Spiros Denaxas Harry Hemingway Ajay M. Shah Derek M. Yellon Theresa A. McDonagh |
| author_facet | Thomas R. Godec Daniel I. Bromage Mar Pujades‐Rodriguez Antonio Cannatà Arturo Gonzalez‐Izquierdo Spiros Denaxas Harry Hemingway Ajay M. Shah Derek M. Yellon Theresa A. McDonagh |
| author_sort | Thomas R. Godec |
| collection | DOAJ |
| description | Abstract Aim The optimal strategy for diabetes control in patients with heart failure (HF) following myocardial infarction (MI) remains unknown. Metformin, a guideline‐recommended therapy for patients with chronic HF and type 2 diabetes mellitus (T2DM), is associated with reduced mortality and HF hospitalizations. However, worse outcomes have been reported when used at the time of MI. We compared outcomes of patients with T2DM and HF of ischaemic aetiology according to antidiabetic treatment. Methods and results This study used linked data from primary care, hospital admissions, and death registries for 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of cardiovascular mortality and HF hospitalization. The secondary endpoints were the individual components of the primary endpoint and all‐cause mortality. To evaluate the effect of temporal changes in diabetes treatment, antidiabetic medication was included as time‐dependent covariates in survival analyses. The study included 1172 patients with T2DM and prior MI and incident HF between 3 January 1998 and 26 February 2010. Five hundred and ninety‐six patients had the primary outcome over median follow‐up of 2.53 (IQR: 0.98–4.92) years. Adjusted analyses showed a reduced hazard of the composite endpoint for exposure to all antidiabetic medication with hazard ratios (HRs) of 0.50 [95% confidence interval (CI): 0.42–0.59], 0.66 (95% CI: 0.55–0.80), and 0.53 (95% CI: 0.43–0.65), respectively. A similar effect was seen for all‐cause mortality [HRs of 0.43 (95% CI: 0.35–0.52), 0.57 (95% CI: 0.46–0.70), and 0.34 (95% CI: 0.27–0.43), respectively]. Conclusions When considering changes in antidiabetic treatment over time, all drug classes were associated with reduced risk of cardiovascular mortality and HF hospitalization. |
| format | Article |
| id | doaj-art-f703876317f2492089ed6fd1c9b46b95 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-f703876317f2492089ed6fd1c9b46b952025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931608161510.1002/ehf2.13910Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failureThomas R. Godec0Daniel I. Bromage1Mar Pujades‐Rodriguez2Antonio Cannatà3Arturo Gonzalez‐Izquierdo4Spiros Denaxas5Harry Hemingway6Ajay M. Shah7Derek M. Yellon8Theresa A. McDonagh9Department of Medical Statistics, Faculty of Epidemiology and Population Health The London School of Hygiene & Tropical Medicine London UKSchool of Cardiovascular Medicine and Sciences King's College London British Heart Foundation Centre of Excellence, James Black Centre 125 Coldharbour Lane London SE5 9NU UKLeeds Institute of Health Sciences University of Leeds Leeds UKSchool of Cardiovascular Medicine and Sciences King's College London British Heart Foundation Centre of Excellence, James Black Centre 125 Coldharbour Lane London SE5 9NU UKInstitute of Health Informatics University College London London UKInstitute of Health Informatics University College London London UKInstitute of Health Informatics University College London London UKSchool of Cardiovascular Medicine and Sciences King's College London British Heart Foundation Centre of Excellence, James Black Centre 125 Coldharbour Lane London SE5 9NU UKThe Hatter Cardiovascular Institute University College London London UKSchool of Cardiovascular Medicine and Sciences King's College London British Heart Foundation Centre of Excellence, James Black Centre 125 Coldharbour Lane London SE5 9NU UKAbstract Aim The optimal strategy for diabetes control in patients with heart failure (HF) following myocardial infarction (MI) remains unknown. Metformin, a guideline‐recommended therapy for patients with chronic HF and type 2 diabetes mellitus (T2DM), is associated with reduced mortality and HF hospitalizations. However, worse outcomes have been reported when used at the time of MI. We compared outcomes of patients with T2DM and HF of ischaemic aetiology according to antidiabetic treatment. Methods and results This study used linked data from primary care, hospital admissions, and death registries for 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of cardiovascular mortality and HF hospitalization. The secondary endpoints were the individual components of the primary endpoint and all‐cause mortality. To evaluate the effect of temporal changes in diabetes treatment, antidiabetic medication was included as time‐dependent covariates in survival analyses. The study included 1172 patients with T2DM and prior MI and incident HF between 3 January 1998 and 26 February 2010. Five hundred and ninety‐six patients had the primary outcome over median follow‐up of 2.53 (IQR: 0.98–4.92) years. Adjusted analyses showed a reduced hazard of the composite endpoint for exposure to all antidiabetic medication with hazard ratios (HRs) of 0.50 [95% confidence interval (CI): 0.42–0.59], 0.66 (95% CI: 0.55–0.80), and 0.53 (95% CI: 0.43–0.65), respectively. A similar effect was seen for all‐cause mortality [HRs of 0.43 (95% CI: 0.35–0.52), 0.57 (95% CI: 0.46–0.70), and 0.34 (95% CI: 0.27–0.43), respectively]. Conclusions When considering changes in antidiabetic treatment over time, all drug classes were associated with reduced risk of cardiovascular mortality and HF hospitalization.https://doi.org/10.1002/ehf2.13910Heart failureIschaemic cardiomyopathyMetforminOutcomesType 2 diabetesAntidiabetic agents |
| spellingShingle | Thomas R. Godec Daniel I. Bromage Mar Pujades‐Rodriguez Antonio Cannatà Arturo Gonzalez‐Izquierdo Spiros Denaxas Harry Hemingway Ajay M. Shah Derek M. Yellon Theresa A. McDonagh Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure ESC Heart Failure Heart failure Ischaemic cardiomyopathy Metformin Outcomes Type 2 diabetes Antidiabetic agents |
| title | Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure |
| title_full | Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure |
| title_fullStr | Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure |
| title_full_unstemmed | Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure |
| title_short | Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure |
| title_sort | cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure |
| topic | Heart failure Ischaemic cardiomyopathy Metformin Outcomes Type 2 diabetes Antidiabetic agents |
| url | https://doi.org/10.1002/ehf2.13910 |
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