AHA: Type 2 diabetes mellitus a risk factor for heart failure

Type 2 diabetes mellitus is a risk factor for incident heart failure, according to a new scientific statement from the American Heart Association (AHA), and it increases the risk of morbidity and mortality in patients with established disease.

AHA’s latest scientific statement on diabetes mellitus and heart failure outlines pharmacological therapy and the positive health impacts for patients related to lifestyle modification. The paper also makes recommendations for approaches to future research. 

More than 29 million U.S. adults have type 2 diabetes mellitus, and, worldwide, its prevalence has increased by 30 percent in the last 10 years, according to the new report. There are 6.5 million people in the United States in heart failure.

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“Secular trends in the prevalence of diabetes mellitus and heart failure forecast a growing burden of disease and underscore the need for effective therapeutic strategies,” the statement adds.

Recent clinical trials have demonstrated the shared pathophysiology between diabetes mellitus and heart failure, the synergistic effect of managing both conditions, and the potential for diabetes mellitus therapies to modulate the risk of heart failure outcomes.

AHA is calling for a team-based approach to caring and managing patients with heart failure and diabetes. In fact, this integrated approach should include:

• Primary clinicians practicing in primary care, cardiology, and endocrinology

• Other clinicians: Pharmacists, dieticians, and physical therapists

• Specialists (when needed): palliative care, nephrology, and hospitalists

• Community resources: social workers, community health workers

“Central to team-based care is the recognition that approaches to chronic disease management require the development of individualized plans of care that consider patient preferences and effective coordination of care across all member of the healthcare team,” the paper states.

Other topics addressed in the paper include: the epidemiology of type 2 diabetes and heart failure, pathophysiology, medical management including glycemic goals, considerations of glucose-lowering medications (metformin, sulfonylureas, thiazolidinediones, insulins, GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors), considerations relating to heart failure therapies (angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta blockers, ivabradine, mineralocorticoid receptor antagonists (MRA), and ICD/CRT, clinical considerations with patients with chronic kidney disease.

AHA’s clinical statement was approved by the American Heart Association Science Advisory and Coordinating Committee on February 12, 2019; the American Heart Association Executive Committee on February 19, 2019; and the Heart Failure Society of America on January 23, 2019.

The downloadable report was authored by Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, Deswal A, Dickson VV, Kosiborod MN, Lekavich CL, McCoy RG, Mentz RJ, Piña IL; on behalf of the American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and the Heart Failure Society of America. Type 2 diabetes mellitus and heart failure: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation. 2019;139:e000–e000. doi: 10.1161/CIR.0000000000000691.