Which medication may increase the risk of heart failure hospitalizations in patients with type 2 diabetes and existing heart or kidney disease?

Study for the Board Certified Cardiology Pharmacist Exam. Utilize flashcards and answer multiple-choice questions with detailed explanations. Prepare efficiently for your certification!

Alogliptin is associated with an increased risk of heart failure hospitalizations, particularly in patients with type 2 diabetes and preexisting heart or kidney disease. The mechanism underlying this risk may relate to the drug’s impact on fluid retention, a side effect that can exacerbate heart failure symptoms in susceptible individuals. In clinical trials, alogliptin demonstrated a neutral effect on cardiovascular outcomes overall; however, the subgroup of patients with existing heart failure showed an increased likelihood of hospitalization.

In contrast, metformin is well-established as a first-line medication for type 2 diabetes and is generally considered safe with a neutral to beneficial effect on heart failure risk. Empagliflozin, an SGLT2 inhibitor, has demonstrated cardiovascular benefits, including a reduction in hospitalizations for heart failure in patients with diabetes, and is actually preferred in patients with established heart failure. Liraglutide, a GLP-1 receptor agonist, has also been shown to reduce cardiovascular risk and improve outcomes in patients with diabetes, particularly in those with heart disease, making it a safer option for this population.

This distinction in how these medications affect heart failure risk is critical for clinicians when managing patients with coexisting diabetes and cardiac or renal conditions.

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