ABSTRACT
Diabetes is a common condition with a dismal prognosis. According to the International Diabetes Federation, 537 million people worldwide have diabetes. Cardiovascular disorders (CVD) are the major cause of death globally. Diabetes mellitus type 2 (T2DM) increases the risk of CVD. Since 2008, the FDA has required all new antihyperglycemic treatments to show no increased CV risk. Years of glucocentric diabetic therapy have left many patients on medicines with no known CV benefit. GLP-1 receptor agonists (GLP-1RAs) are excellent glucose-lowering medicines with little risk of hypoglycaemia, CVD and weight loss. GLP-1RAs may also delay renal disease development. As an adjunct to metformin or ongoing therapy, GLP1RAs or sodium-glucose cotransporter-2 inhibitors are recommended by the American Diabetes Association and the European Association for the Study of Diabetes (EASD). Thus, this review summarises GLP-1RA and their significance in the paradigm shift in diabetes care recommendations from glucocentric to gluco-cardiocentric
ABSTRACT
Heart failure with preserved ejection fraction (HFpEF) accounts for 15–20% of patients with heart failure (HF) in India. Diagnosis is by clinical features supported by biomarkers and echocardiography. Lifestyle modifications, control of risk factors to optimum levels, and treatment of comorbidities are essential in the management of HFpEF. Spironolactone and sacubitril-valsartan [angiotensin receptor neprilysin inhibitor (ARNI)] are beneficial in subsets of HFpEF, especially with lower range of ejection fraction (EF). Sodium-glucose co-transporter-2 inhibitors (SGLT2i)—empagliflozin and dapagliflozin and probably sotagliflozin are the only currently available drugs which have shown benefits in HFpEF, mostly by reducing hospitalizations. The benefit of SGLT2i is evident in both diabetic and nondiabetic subsets. Heart failure with preserved ejection fraction is defined as patients with HF with documented left ventricular ejection fraction (LVEF) equal to or more than 50%.1 Globally, HFpEF accounts for close to 50% of patients presenting with HF. As per the registry data like Trivandrum Heart Failure Registry2 and ASIAN-HF,3 the proportion of HFpEF in our country is approximately 19–25%, which is much lower as compared to that of western population. There is a possibility that many cases go undiagnosed in developing countries like India. The mean age of presentation of patients from India was around 58–68 years, which is about 10 years younger than the data reported from the west. Heart failure with preserved ejection fraction is characterized by elevated left ventricular filling pressures and/or reduced cardiac output either at rest or on exertion. Cardiac output is maintained at the cost of abnormally elevated filling pressure which is responsible for the symptoms and signs. Neurohumoral activation (sympathetic and renin-angiotensin-aldosterone system activation) is present only in a group of HFpEF patients unlike in patients with heart failure with reduced ejection fraction (HfrEF).