A “tidal wave” of heart failure is coming for patients with type 2 diabetes, as forecasts predict the condition will affect 8.7 million Americans by 2030, 10.3 million by 2040, and 11.4 million by 2050. These projections, shared by Adrian F. Hernandez, MD, MHS, are based on demographic changes, including an aging population and the continued prevalence of risk factors like obesity and diabetes.

“This combination of worsening risk factors, plus surviving initial insults from diabetes, turns into a growing burden of heart failure nationally if we don’t bend the curve on risk factors,” said Dr. Hernandez, Duke Health Cardiology Distinguished Professor, Executive Director of the Duke Clinical Research Institute, and Vice Dean of the Duke University School of Medicine. “Specifically, by 2050, the estimate of diabetes will go from 16% to 27%, and obesity will go from 43% to 61%.”

Dr. Hernandez and colleagues will discuss the scope of the issue during the symposium, The Tidal Wave Is Coming—Heart Failure Diagnosis, Prevention, and Treatment in Patients with Type 2 Diabetes, on Saturday, June 21, from 3:15–4:15 p.m., in Room W375 A of the McCormick Place Convention Center. On-demand access to recorded presentations will be available to registered participants following the conclusion of the 85^th Scientific Sessions, from June 25–August 25.

Two major pharmaceutical developments Dr. Hernandez will cover are sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.

“SGLT2 inhibitors have shown significant cardiovascular benefits across the spectrum,” he noted, with clinical trials having demonstrated a reduction in the risk of worsening heart failure and cardiovascular death in patients with heart failure. Now, GLP-1 receptor agonists have shown benefits for the potential prevention of heart failure through improved cardiovascular risk factors and reduction in obesity.

Inflammation has long been known to play a role in the development of heart failure, either directly or indirectly post-myocardial infarction, Dr. Hernandez noted.

“Emerging evidence suggests anti-inflammatory agents may have a role in prevention or treatment of heart failure as well as a potential complementary mechanism for agents such as GLP-1 receptor agonists in improving outcomes of patients with heart failure,” he explained.

It is also imperative that physicians caring for patients with diabetes identify the individuals at highest risk for heart failure as early as possible.

“Given how common heart failure is becoming among individuals with diabetes, this is an all-hands-on-deck situation,” said James L. Januzzi, MD, the Adolph Hutter Professor of Medicine at Harvard Medical School, Staff Cardiologist at Massachusetts General Hospital, and Chief Scientific Officer at Baim Institute for Clinical Research. He will discuss risk stratification tools, biomarkers, and imaging for the screening and prevention of heart failure. “We have the tools to recognize patients at risk and treat them. The tests are widely available, inexpensive, and easy to interpret, and there are therapeutic interventions that we know work to reduce risk.”

It’s never too soon to evaluate these patients.

“We would much rather prevent heart failure than treat it,” Dr. Januzzi emphasized. “Once a patient has abnormal biomarkers, they already have Stage B heart failure (cardiac dysfunction even in the absence of an overt diagnosis). These people are at high risk for progression to symptomatic heart failure but can still be pulled back with early and appropriate treatment.”

The panel also includes Ravi Patel, MD, MSc, of Northwestern University Feinberg School of Medicine, who will discuss the etiology of heart failure with preserved ejection fraction (HFpEF) with a focus on the role of diabetes