Heart failure and dipeptidyl peptidase-4 inhibitors

Heart failure is a major co-morbid association of diabetes mellitus. The incidence of heart failure in diabetic vs. control subjects is 2- to 3-fold greater in every decade of life.1 Similar data on prevalence have also been observed in the Framingham study.2 Conversely, diabetes represents a major co-morbidity in patients with heart failure. In both clinical trials and registries of heart failure patients, between 24 and 44 have known diabetes mellitus.3 A key epidemiological issue in the context of discussion of therapies for diabetes and the associated risk of heart failure is the impact of glycaemic control on heart failure risk. Both UKPDS4 and a large cohort investigated by Iribarren et al.5 have demonstrated a close positive linear relationship between haemoglobin A1c levels and rate of heart failure development. Specifically, poorest glycaemic control was associated with greatest risk of heart failure. However, studies such as UKPDS demonstrated that more intensive glycaemic control was not associated with reduced development of heart failure.6 More contemporaneous meta-analyses have supported this observation,7 albeit potentially driven by drug treatments such as thiazolidinediones which may contribute to heart failure development.