The landscape of novel antidiabetic drugs in diabetic HFpEF: relevant mechanisms and clinical implications

• Published in: Cardiovascular diabetology Vol. 24; no. 1; pp. 186 - 14
• Main Authors: Duan, Xiangling, Zhang, Xiaomeng, Sun, Bao
• Format: Journal Article
• Language: English
• Published: England BioMed Central 28.04.2025; BMC
• Subjects: Animals; Antidiabetics; Biomarkers; Blood Glucose - drug effects; Blood Glucose - metabolism; Cardiac function; Cardiovascular system; Congestive heart failure; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; Dipeptidyl-Peptidase IV Inhibitors - adverse effects; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; DPP4i; Drugs; Ejection fraction; Epidemiology; Fatty acids; GLP-1 RA; Glucagon; Glucagon-like peptide 1; Glucagon-Like Peptide-1 Receptor Agonists; Heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - epidemiology; Heart Failure - physiopathology; HFpEF; Hospitalization; Humans; Hyperglycemia; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Incretins - adverse effects; Incretins - therapeutic use; Males; Metabolism; Mortality; Oxidative stress; Pathophysiology; Peptides; Review; Risk Factors; SGLT2i; Signal Transduction; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stroke Volume - drug effects; T2DM; Treatment Outcome; Ventricular Function, Left - drug effects; United States > US; GLP-1 RA; T2DM; DPP4i; HFpEF; SGLT2i
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-025-02750-4

As a heterogeneous syndrome, heart failure with preserved ejection fraction (HFpEF) has become the leading form of heart failure worldwide. Increasing evidence has identified that diabetes mellitus (DM) increases the risk of HFpEF. Worse still, the coexistence of both diseases poses a great threat to human health by further worsening the cardiovascular system and accelerating the progression of diabetes. Although several studies have indicated that the novel antidiabetic drugs, including sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dipeptidyl peptidase 4 inhibitors (DPP4i) provide the cardiovascular benefits in T2DM patients with HFpEF, the elaborated roles and mechanisms are not fully understood. In this review, we summarize the state-of-the-art evidence regarding the epidemiology and pathophysiology of diabetic HFpEF, and the landscape of the novel antidiabetic drugs in the treatment of diabetic HFpEF, as well as discuss the relevant mechanisms, aiming to broaden the understanding of diabetic HFpEF and gain new insight into the treatment of this disease.