Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure

JACC Heart Fail. 2015 Feb;3(2):136-45. doi: 10.1016/j.jchf.2014.08.004.

Abstract

The prevalence of patients with concomitant heart failure (HF) and diabetes mellitus (DM) continues to increase with the general aging of the population. In patients with chronic HF, prevalence of DM is 24% compared with 40% in those hospitalized with worsening HF. Patients with concomitant HF and DM have diverse pathophysiologic, metabolic, and neurohormonal abnormalities that potentially contribute to worse outcomes than those without comorbid DM. In addition, although stable HF outpatients with DM show responses that are similar to those of patients without DM undergoing evidence-based therapies, it is unclear whether hospitalized HF patients with DM will respond similarly to novel investigational therapies. These data support the need to re-evaluate the epidemiology, pathophysiology, and therapy of HF patients with concomitant DM. This paper discusses the role of DM in HF patients and underscores the potential need for the development of targeted therapies.

Keywords: diabetes mellitus; diabetic cardiomyopathy; heart failure.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Autonomic Nervous System Diseases / physiopathology
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / physiopathology*
  • Diuretics / therapeutic use
  • Fatty Acids, Nonesterified / metabolism
  • Heart / physiopathology
  • Heart Failure / epidemiology
  • Heart Failure / physiopathology*
  • Heart Failure / therapy*
  • Humans
  • Insulin Resistance / physiology
  • Mitochondria, Heart / physiology
  • Myocardium / metabolism
  • Renal Insufficiency / physiopathology
  • Renin-Angiotensin System / drug effects
  • Renin-Angiotensin System / physiology
  • Vascular Remodeling / physiology

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Diuretics
  • Fatty Acids, Nonesterified