Concerns have arisen regarding risk of heart failure with oral dipeptidyl peptidase 4 (DPP4) inhibitors. In a prespecified secondary analysis of the TECOS trial, McGuire and coauthors studied 14鈥�671 patients with type 2 diabetes and atherosclerotic vascular disease and report no differences in heart failure hospitalizations between the patients randomized to sitagliptin or placebo. A meta-analysis of these data with 2 other trials showed no difference between DPP4 inhibitors and placebo with respect to heart failure hospitalizations or cardiovascular death. In an Editorial, Scirica notes that lowering glucose with a good cardiovascular safety profile is an important clinical need, but ultimately we need diabetes drugs that also reduce cardiovascular risk.
Despite beneficial effects, statins increase the risk of developing diabetes. Dugani and coauthors explored risk factors associated with incident diabetes in 11鈥�918 nondiabetic participants enrolled in the JUPITER trial, a clinical trial of rosuvastatin vs placebo. A lipoprotein insulin resistance (LPIR) score based on size and concentration of lipoprotein particles was positively associated with incident diabetes during rosuvastatin therapy. In an Invited Commentary, Pagidipati and coauthors discuss that the components of the LPIR score correlate with glucose clearance and insulin resistance and that further research is needed to determine whether LPIR is a cause or consequence of the pathways that lead to diabetes.
Gerber and coauthors followed up 1922 patients with a first myocardial infarction (MI) and no history of heart failure. The extent of angiographically defined coronary artery disease at baseline was significantly associated with subsequent development of heart failure鈥攂oth heart failure with reduced ejection fraction and with preserved ejection fraction. These trends were independent of recurrent MI. This study underscores the need for further investigation of the transition from initial myocardial injury to heart failure.
Using a nationwide Swedish registry, Bj枚rck and coauthors evaluated outcomes in more than 40鈥�000 patients treated with warfarin for nonvalvular atrial fibrillation from 2006 to 2011. Complication rates were low in those whose time in therapeutic range (TTR) was 70% or greater compared with those with TTR less than 70% or high international normalized ratio variability. These data indicate, in the era of new oral anticoagulant drugs, that well-managed warfarin treatment is a valid alternative when treating patients with atrial fibrillation. In an Editorial, Alexander and Thomas discuss whether the analysis can inform treatment decisions.
Chan and coauthors investigated the American Heart Association Get With the Guidelines Resuscitation database to identify factors associated with survival after in-hospital cardiac arrest. Adjusted survival rates varied substantially among 150 hospitals. Three practices that were associated with survival (tracking interruptions in chest compressions, reviewing cardiac arrest cases monthly or quarterly, and adequate resuscitation training) can identify best practices for in-hospital resuscitation care.