Chronic heart failure and type 2 diabetes mellitus: prospects for optimizing pharmacotherapy of comorbid pathology
The objective is to provide an overview of the literature data concerning the optimization of pharmacotherapy of comorbid pathology - chronic heart failure and diabetes mellitus. The article discusses the pathogenetic mechanisms of the negative mutual influence of chronic heart failure (CHF) and type 2 diabetes mellitus (T2DM) on their course and prognosis in patients with this comorbid pathology. Along with the discussion of the leading groups of drugs used for the treatment of CHF with a reduced left ventricular ejection fraction in patients with T2DM, priority classes of drugs for the treatment of patients with diastolic heart failure and their effect on the prognosis in the discussed contingent of patients are considered. An important area of therapy for people with CHF and T2DM is the use of hypoglycemic drugs that can have a positive effect on the course of cardiac pathology and change the prognosis in such patients. The article discusses the results of a number of randomized clinical trials evaluating the cardioprotective effect of modern classes of hypoglycemic agents: dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose cotransporter-2 (SGLT-2) inhibitors. According to the presented studies, DPP-4 inhibitors, GLP-1 receptor agonists had a neutral or favorable effect on the prognosis in patients with cardiovascular diseases of atherosclerotic genesis and/or risk factors for their development, but did not affect the course of CHF. For the current period, the most significant drugs in terms of a positive effect on the prognosis in patients with diabetes mellitus and CHF are those from the SGLT-2 inhibitors group. The paper discusses in detail the results of clinical studies on the use of agents of the above-mentioned group in persons with CHF and diabetes mellitus and reviews the pharmacodynamic mechanisms that determine the cardioprotective effect of these drugs. The paper presents modern data that allow discussing the prospects for the use of SGLT-2 inhibitors in patients with CHF without T2DM.