Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and associated with considerable morbidity and mortality. Significant advances have recently occurred in the treatment of T2DM, with evidence of several new glucose-lowering medications showing either neutral or beneficial cardiovascular effects. However, some of these agents have safety characteristics with strong practical implications in HF [i.e. dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter type 2 (SGLT-2) inhibitors]. Regarding safety of DPP-4 inhibitors, saxagliptin is not recommended in HF because of a greater risk of HF hospitalisation. There is no compelling evidence of excess HF risk with the other DPP-4 inhibitors. GLP-1 RAs have an overall neutral effect on HF outcomes. However, a signal of harm suggested in two small trials of liraglutide in patients with reduced ejection fraction indicates that their role remains to be defined in established HF. SGLT-2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) have shown a consistent reduction in the risk of HF hospitalisation regardless of baseline cardiovascular risk or history of HF. Accordingly, SGLT-2 inhibitors could be recommended to prevent HF hospitalisation in patients with T2DM and established cardiovascular disease or with multiple risk factors. The recently completed trial with dapagliflozin has shown a significant reduction in cardiovascular mortality and HF events in patients with HF and reduced ejection fraction, with or without T2DM. Several ongoing trials will assess whether the results observed with dapagliflozin could be extended to other SGLT-2 inhibitors in the treatment of HF, with either preserved or reduced ejection fraction, regardless of the presence of T2DM. This position paper aims to summarise relevant clinical trial evidence concerning the role and safety of new glucose-lowering therapies in patients with HF.

中文翻译：

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欧洲心脏病学/心力衰竭协会关于新的降糖药物在心力衰竭患者中的​​作用和安全性的立场文件。

2型糖尿病（T2DM）在心力衰竭（HF）患者中很常见，并具有较高的发病率和死亡率。最近在T2DM的治疗方面取得了重大进展，有证据表明几种新的降糖药物显示出中性或有益的心血管作用。但是，这些药物中的某些具有安全性，在HF中具有很强的实际意义[即，二肽基肽酶4（DPP-4）抑制剂，胰高血糖素样肽1受体激动剂（GLP-1 RA）和钠葡萄糖共转运蛋白2型（SGLT-2）抑制剂]。关于DPP-4抑制剂的安全性，不建议使用沙格列汀治疗心衰，因为心衰住院的风险更大。没有令人信服的证据表明使用其他DPP-4抑制剂会引起过量的HF风险。GLP-1 RA对HF结果具有总体中性作用。但是，在两项射血分数降低的利拉鲁肽的小型试验中表明存在伤害信号，表明其作用尚待确定。SGLT-2抑制剂（依格列净，canagliflozin和dapagliflozin）已显示出持续降低的HF住院风险，而与基线心血管疾病风险或HF史无关。因此，可以推荐使用SGLT-2抑制剂来预防患有T2DM和已确定的心血管疾病或具有多种危险因素的HF患者住院。最近完成的使用达格列净的试验显示，无论是否患有T2DM，HF患者的心血管疾病死亡率和HF事件均显着降低，射血分数降低。数项正在进行的试验将评估达格列净治疗组观察到的结果是否可以扩展至其他SGLT-2抑制剂，无论是否存在T2DM，其射血分数均得以保留或降低。本立场文件旨在总结有关新的降糖疗法在心衰患者中的作用和安全性的相关临床试验证据。