The impact of diabetes on heart failure development: the cardio-renal-metabolic connection

Paul Valensi (1, 2) , Gaétan Prévost (3) , Sara Pinto (2, 1) , Jean-Michel Halimi (4) , Erwan Donal (5, 6)

1 Service d'endocrinologie diabétologie, nutrition (Hôpital Jean Verdier)
2 CRNH-IDF - Centre de Recherche en Nutrition Humaine d'Ile-de-France
3 CHU Rouen
4 Service de néphrologie et immunologie clinique [CHRU Tours]
5 LTSI - Laboratoire Traitement du Signal et de l'Image
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]

Heart failure (HF) and chronic kidney disease (CKD) are often associated in type 2 diabetes (T2D), aggravate each other and exert synergistic effects to increase the risk of cardiac and renal events. The risks of renal worsening in HF patients and HF in CKD patients need to be evaluated to tailor preventive therapy. The recent CV and renal trials enriched our knowledge about the natural history of HF and CKD in T2D and provided evidence for the benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in HF and renal decline prevention. SGLT-2is are the best choice in patients with HFrEF to improve CV prognosis and HF-related outcomes and also to prevent kidney-related outcomes, and in CKD patients to slow down renal failure and also reduce hHF and CV death. In both situations the number of patients to treat in order to prevent such events in one patient is lower than in the general T2D population at high CV risk. GLP1-receptor agonists could be an alternative in a patient who is intolerant or has a contraindication to SGLT-2is. A tight collaboration between diabetologists, nephrologists and cardiologists should be encouraged for a holistic and effective strategy to reduce the burden of cardio-renal-metabolic interaction.

Mots clés: Diabetes; GLP1-receptor agonists; SGLT2 inhibitors; chronic kidney disease; coronary artery disease; heart failure

Domaines: Ingénierie biomédicale; Cardiologie et système cardiovasculaire; Urologie et Néphrologie

Paul Valensi, Gaétan Prévost, Sara Pinto, Jean-Michel Halimi, Erwan Donal. The impact of diabetes on heart failure development: the cardio-renal-metabolic connection. Diabetes Research and Clinical Practice, 2021, 175, pp.108831. ⟨10.1016/j.diabres.2021.108831⟩. ⟨hal-03222646⟩