Hypoglycemic drugs and drug-induced heart failure

DOI: https://dx.doi.org/10.18565/pharmateca.2019.14.10-21

O.D. Ostroumova (1, 2), I.V. Goloborodova (2)

1) Russian Clinical and Research Center of Gerontology, N.I. Pirogov Russian National Research Medical University, Moscow, Russia; 2) A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
Heart failure (HF) is one of the main causes of morbidity and mortality worldwide, including in the Russian Federation. HF is also one of the main reasons for hospitalization of patients, contributing to an increase in length of hospital stay and worsening prognosis after discharge, and having a heavy incidence both for patients and the health care system as a whole. The etiological structure of heart failure includes both numerous cardiovascular diseases and related conditions that can lead to its development. The effect of drugs is one of the reasons that can lead to the development or aggravation of an existing HF, so-called drug-induced HF. Currently, there are known drugs that can lead to the development/aggravation of HF, and drugs that are only in some cases considered as a possible reason for the development of drug-induced HF. One of the groups of drugs that contribute to the development or progression of HF is a group of hypoglicemic drugs. So, thiazolidinediones increase the risk of progression of HF in patients with type 2 diabetes mellitus (DM2), and insulin, like sulfonylureas, have the potential to aggravate the course of existing HF. On the contrary, metformin is a safe drug for the treatment of diabetic patients with HF. Sitagliptin and linagliptin, representatives of the group of dipeptidyl peptidase-4 inhibitors, are also used in patients with DM2 and HF, unlike saxagliptin, whose use is associated with the development/progression of HF. Considering that diabetic patients initially have increased cardiovascular risks, the need for awareness of the cardiovascular safety of certain groups of hypoglicemic drugs is very important. Understanding the characteristics of the relationship of certain hypoglicemic drugs with cardiovascular risks, including the risk of development/progression of HF, can have a positive effect on the effectiveness of treatment and clinical outcomes in individual patients, as well as contribute to reducing the “disease burden” in whole.
Keywords: heart failure, type 2 diabetes mellitus, side effects of drugs, hypoglicemic drugs, insulin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors

About the Autors

Corresponding author: Olga D. Ostroumova, MD, Professor, Head of Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Clinical and Research Center of Gerontology, N.I. Pirogov Russian National Research Medical University, Moscow, Russia; e-mail: ostroumova.olga@mail.ru
Address: 16, 1st Leonov Street, Moscow 129226, Russian Federation

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