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Lancet Diabetes Endocrinol. 2014 Oct;2(10):843-51. doi: 10.1016/S2213-8587(14)70031-2. Epub 2014 Mar 13.

Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored.

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BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. Electronic address:
Department of Medicine and Department of Clinical Epidemiology and Biostatistics, McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.


In patients with type 1 or type 2 diabetes, glycaemic exposure assessed as HbA1c correlates strongly with risk of future microvascular and macrovascular complications. Improved glucose control substantially reduces the risk of microvascular complications and, with extended follow-up, modestly reduces the risk of atherosclerotic events. The lowering of HbA1c concentrations by newly developed glucose-lowering drugs (alone or when added to other glucose-lowering drugs) has been used, until recently, as a surrogate measure of their potential to lower cardiovascular risk. This assumption is no longer acceptable, and now demonstration of cardiovascular safety has been mandated by regulatory authorities. A major concern, however, is the universal absence in any large-scale trials of new glucose-lowering drugs of hospital admission for heart failure as a prespecified component of the primary composite cardiovascular outcomes. This omission is important because hospital admission for heart failure is a common and prognostically important cardiovascular complication of diabetes. Moreover, it is the one cardiovascular outcome for which the risk has been shown unequivocally to be increased by some glucose-lowering therapies. As such, we believe that heart failure should be systematically evaluated in cardiovascular outcome trials of all new glucose-lowering drugs.

[Indexed for MEDLINE]

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