Abstract
Heart failure with preserved ejection fraction (HFpEF) is now the most common form of HF, affecting over 3 million adults in the United States alone. HFpEF is a heterogenous syndrome. One important phenotype may be related to comorbid conditions, including diabetes mellitus (DM). DM has a prevalence of approximately 45% in HFpEF, but characteristics and outcomes of this population are poorly understood. In this review, the authors summarize data from several clinical trials of HFpEF therapeutics and provide original data from a large cohort using the Get With The Guidelines-HF registry, which together suggest that DM is associated with increased morbidity and long-term mortality in HFpEF. The authors then discuss several common pathological mechanisms in HFpEF and DM, including sodium retention, metabolic derangements, impaired skeletal muscle function, and potential therapeutic targets. As the understanding of comorbid HFpEF and DM improves, it is hoped clinicians will be better equipped to offer effective, patient-centered treatments.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 602-611 |
| Number of pages | 10 |
| Journal | Journal of the American College of Cardiology |
| Volume | 73 |
| Issue number | 5 |
| DOIs | |
| State | Published - Feb 12 2019 |
Funding
This work was supported by American Heart Association grant #16SFRN30180010 to Dr. Hernandez. The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Dr. DeVore has received research support from Akros Medical, the American Heart Association, Amgen, Bayer, Intra-Cellular Therapies, Luitpold Pharmaceuticals, the National Heart, Lung, and Blood Institute, Novartis, and the Patient-Centered Outcomes Research Institute; and has served as a consultant for Novartis. Dr. Wu is an employee of Cytel. Dr. Fonarow has received research support from the National Institutes of Health; and has served as a consultant for Amgen, Abbott, Janssen, Medtronic, Novartis, and St. Jude Medical. Dr. Yancy serves as chair of the American Heart Association GWTG-Heart Failure Subcommittee. Dr. Green has received research support from AstraZeneca/Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Sanofi, and Intarcia Therapeutics; and has served as a consultant for AstraZeneca, Merck Sharp & Dohme, Daiichi-Sankyo Company, Boehringer Ingelheim Pharmaceuticals, Sanofi/Regeneron, and Novo Nordisk. Dr. Altman has received research support from the American Heart Association. Dr. Hernandez has received research support from AstraZeneca, GlaxoSmithKline, Luitpold, Merck, and Novartis; and has served as a consultant to Bayer, Boston Scientific, Merck, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Keywords
- clinical trials
- comorbidity
- heart failure
- registries
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
