Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure

Thomas R. Godec, Daniel I. Bromage*, Mar Pujades-Rodriguez, Antonio Cannatà, Arturo Gonzalez-Izquierdo, Spiros Denaxas, Harry Hemingway, Ajay M. Shah, Derek M. Yellon, Theresa A. McDonagh

*Corresponding author for this work

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Aim: The optimal strategy for diabetes control in patients with heart failure (HF) following myocardial infarction (MI) remains unknown. Metformin, a guideline-recommended therapy for patients with chronic HF and type 2 diabetes mellitus (T2DM), is associated with reduced mortality and HF hospitalizations. However, worse outcomes have been reported when used at the time of MI. We compared outcomes of patients with T2DM and HF of ischaemic aetiology according to antidiabetic treatment. Methods and results: This study used linked data from primary care, hospital admissions, and death registries for 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of cardiovascular mortality and HF hospitalization. The secondary endpoints were the individual components of the primary endpoint and all-cause mortality. To evaluate the effect of temporal changes in diabetes treatment, antidiabetic medication was included as time-dependent covariates in survival analyses. The study included 1172 patients with T2DM and prior MI and incident HF between 3 January 1998 and 26 February 2010. Five hundred and ninety-six patients had the primary outcome over median follow-up of 2.53 (IQR: 0.98–4.92) years. Adjusted analyses showed a reduced hazard of the composite endpoint for exposure to all antidiabetic medication with hazard ratios (HRs) of 0.50 [95% confidence interval (CI): 0.42–0.59], 0.66 (95% CI: 0.55–0.80), and 0.53 (95% CI: 0.43–0.65), respectively. A similar effect was seen for all-cause mortality [HRs of 0.43 (95% CI: 0.35–0.52), 0.57 (95% CI: 0.46–0.70), and 0.34 (95% CI: 0.27–0.43), respectively]. Conclusions: When considering changes in antidiabetic treatment over time, all drug classes were associated with reduced risk of cardiovascular mortality and HF hospitalization.

Original languageEnglish
Pages (from-to)1608-1615
Number of pages8
JournalESC Heart Failure
Issue number3
Early online date23 Mar 2022
Publication statusPublished - Jun 2022


  • Antidiabetic agents
  • Heart failure
  • Ischaemic cardiomyopathy
  • Metformin
  • Outcomes
  • Type 2 diabetes


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