Impairment of cardiac isch- emic preconditioning does not seem to occur with more selective and newer-generation sulfonylureas.166 The incretin-based therapies (glucagon-like peptide-1 hibitors) have emerged as a new class of hyperglycemic medications. The side-effect profile of these medications when used as monotherapy (less risk of hypoglycemia and association with modest weight loss with GLP-1 ago- nists) represents potential benefits, but the safety and efficacy of DPP-4 inhibitors and GLP-1 agonists have not been studied extensively in patients with established HF. Human studies of DPP-4 inhibitors or GLP-1 based thera- pies have also been limited by HF not being identified as a prospective primary outcome, and these limited studies in patients with HF have yielded mixed results in cardio- vascular versus HF outcomes.167 170 Although there were no significant changes with the use of DPP-4 inhibitors in cardiovascular outcomes in large-scale clinical stud- the SAVOR-TIMI 53 trial (Saxagliptin Assess- ment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus Thrombolysis in Myocardial Infarction), reported by Scirica et al,172 showed a 27% increase in hospitalization for HF among patients with diabetes mel- litus who received saxagliptin compared with placebo. In this trial, 12.8% of patients had a history of HF at baseline. The composite risk of cardiovascular events and hospitalization for HF was similar for patients with history of HF compared with patients without a history of HF with the use of saxagliptin.173 A recent meta-anal- ysis of available studies suggests that DPP-4 inhibitor use is associated with an increased risk of HF, without any clear evidence of differences among drugs of that Additional studies are being conducted to as- sess the cardiovascular efficacy of DPP-4 inhibitors and GLP-1 based therapies, with HF being measured as a secondary outcome. 