ABSTRACT
We aimed to describe and compare characteristics and outcomes of patients with a worsening heart failure episode included in the RECOLFACA registry during 2017-2019 vs population from VICTORIA trial. 2528 patients were included, 1890 (74.8%) had an ejection fraction <45% and a worsening episode. VICTORIA population was similar to RECOLFACA patients in mean age (67.3 vs 66.9 years), ejection fraction (28.9% vs 28.4%), the prevalence of COPD (17.1% vs 15.7%), and the median eGFR (61.5 vs 61.4 mL/min/1.73m2). RECOLFACA patients were mostly women, with a lower prevalence of atrial fibrillation, diabetes mellitus, and coronary artery disease. The 1-year heart failure hospitalization rate was 29.6% in the placebo group of VICTORIA, compared to 26.9% in RECOLFACA. Patients enrolled in the RECOLFACA that met the VICTORIA definition had more similar characteristics and outcomes compared to the VICTORIA population. There is an opportunity to improve this unmet need with the use of vericiguat.
Subject(s)
Atrial Fibrillation , Heart Failure , Aged , Colombia , Female , Humans , Male , Registries , Stroke VolumeABSTRACT
Resumen La hipoglicemia aguda y crónica, inducida por insulina u otros antidiabéticos orales, en un contexto terapéutico, constituye un factor de riesgo cardiovascular, generador de disfunción endotelial y aterogénesis a través de mecanismos proinflamatorios, tanto o más relevante que la hiperglicemia, con el agravante de inducir muerte súbita arritmogénica e isquémica. Conclusión: La hipoglicemia constituye una amenaza real para el miocardio, no solo por sus efectos proarrítmicos inmediatos, que pueden relacionarse con síndrome de muerte súbita, sino también por los efectos proinflamatorios y aterogénicos que constituyen un factor de riesgo importante para el desarrollo de enfermedad cardiovascular. Por tanto, es deseable, y clínicamente pertinente, evitar los episodios de hipoglicemia de cualquier intensidad y duración en todo tipo de paciente diabético, en especial en aquellos que presenten un sustrato miocárdico patológico que confiera incremento del riesgo de muerte súbita: función sistólica comprometida, arritmias ventriculares, fibrilación atrial, enfermedad coronaria, miocardiopatía hipertrófica, genotipo arritmogénico y antecedentes de reanimación.
Abstract Acute or chronic hypoglycaemia, induced by insulin or other oral antidiabetic drugs cin a therapeutic context, constitutes a cardiovascular risk factor. It leads to endothelial dysfunction and atherogenesis through pro-inflammatory mechanisms, as much as or more important than hyperglycaemia, with the aggravating factor of inducing arrhythmogenic and ischaemic sudden death. Conclusion: Hypoglycaemia is a real threat for the myocardium, not only due to its immediate pro-arrhythmic effects, that may be associated with sudden death syndrome, but also due to the pro-inflammatory and atherogenic effects. These are all significant risk factors for the development of cardiovascular disease, making it desirable, and clinically relevant to prevent hypoglycaemic episodes of any intensity and duration in any type of diabetic patient. This is particularly important in those that have a pathological myocardial substrate that can lead to an increase in the risk of sudden death: compromised systole function, ventricular arrhythmias, atrial fibrillation, coronary disease, hypertrophic cardiomyopathy, arrhythmogenic genotype, and a history of resuscitation.
