Letter by Gazmuri and Karmazyn Regarding Article, “Activation and Inhibition of Sodium-Hydrogen Exchanger Is a Mechanism That Links the Pathophysiology and Treatment of Diabetes Mellitus With That of Heart Failure”

In his cogent and succinct review, Packer1 provides compelling evidence summarizing the roles of sodium-hydrogen exchange isoform 1 (NHE1) and isoform 3 (NHE3) as unifying links between diabetes mellitus and heart failure. The experimental evidence for this association is robust and the review by Packer highlights NHE as an attractive therapeutic target for both conditions, correctly pointing out that cariporide, a first-generation NHE1-specific inhibitor, has been shown to protect against myocardial injury in high-risk patients undergoing coronary artery bypass surgery, as reported in the EXPEDITION study …