Therapies for Heart Failure Patients With Type 2 Diabetes and Renal Dysfunction

Larry A. Allen, MD, MHS


May 25, 2023

In patients with heart failure (HF), type 2 diabetes (T2D) and chronic kidney disease (CKD) are common and are associated with increased risk for hospitalization and death.

In this ReCAP, Dr Larry Allen, of the University of Colorado School of Medicine, discusses how new therapies, sodium-glucose cotransporter 2 (SGLT2) inhibitors and the mineralocorticoid receptor agonists (MRAs), appear to slow HF progression in patients with T2D and renal dysfunction. These agents also have been shown to reduce the risk for HF hospitalization and death in these patients.

Dr Allen highlights the RALES trial, which examined the MRA spironolactone in patients with severe HF with reduced ejection fraction (HFrEF). The study showed the MRA resulted in a 30% risk reduction in cardiovascular death and HF hospitalization. He notes the EMPHASIS-HF study, which examined eplerenone in mild HFrEF, led to a similar outcome.

Recently, the FIDELIO-DKD and FIGARO-DKD trials used the MRA finerenone in patients with T2D and a broad spectrum of CKDs. The studies showed that the MRA reduced the risk for clinically important kidney and cardiovascular outcomes.

Finally, he discusses SGLT2s, such as dapagliflozin, empagliflozin, and canagliflozin. Initially studied in patients with T2D, all three agents have been shown to extend health benefits to patients with HF across all ejection fractions and across relevant comorbidities.


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