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      Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored.

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          Abstract

          In patients with type 1 or type 2 diabetes, glycaemic exposure assessed as HbA1c correlates strongly with risk of future microvascular and macrovascular complications. Improved glucose control substantially reduces the risk of microvascular complications and, with extended follow-up, modestly reduces the risk of atherosclerotic events. The lowering of HbA1c concentrations by newly developed glucose-lowering drugs (alone or when added to other glucose-lowering drugs) has been used, until recently, as a surrogate measure of their potential to lower cardiovascular risk. This assumption is no longer acceptable, and now demonstration of cardiovascular safety has been mandated by regulatory authorities. A major concern, however, is the universal absence in any large-scale trials of new glucose-lowering drugs of hospital admission for heart failure as a prespecified component of the primary composite cardiovascular outcomes. This omission is important because hospital admission for heart failure is a common and prognostically important cardiovascular complication of diabetes. Moreover, it is the one cardiovascular outcome for which the risk has been shown unequivocally to be increased by some glucose-lowering therapies. As such, we believe that heart failure should be systematically evaluated in cardiovascular outcome trials of all new glucose-lowering drugs.

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          Author and article information

          Journal
          Lancet Diabetes Endocrinol
          The lancet. Diabetes & endocrinology
          2213-8595
          2213-8587
          Oct 2014
          : 2
          : 10
          Affiliations
          [1 ] BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. Electronic address: john.mcmurray@glasgow.ac.uk.
          [2 ] Department of Medicine and Department of Clinical Epidemiology and Biostatistics, McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
          [3 ] Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
          [4 ] Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
          Article
          S2213-8587(14)70031-2
          10.1016/S2213-8587(14)70031-2
          24731668
          863f3c3c-a627-4ba4-8a6a-6e3e6b3de72c
          Copyright © 2014 Elsevier Ltd. All rights reserved.
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