Diabetes mellitus and heart failure: basic mechanisms, clinical features, and therapeutic considerations
Section snippets
Heart failure in diabetes mellitus: causal and treatment considerations
The combination of hyperglycemia, hypertension, obesity, dyslipidemia, and atherosclerosis that is seen commonly with diabetes mellitus increases the risk of systolic and diastolic left ventricular (LV) dysfunction and often leads to heart failure in diabetic patients; this explains the more common occurrence of this syndrome in diabetic patients [1], [2], [3], [4]. In the United Kingdom Prospective Diabetic Study (UKPDS), the incidence of heart failure correlated with the extent of
Glycemic control
Although intensive glycemic control may not alter indices of systolic function [102], data from the UKPDS clearly demonstrated that intensive blood pressure reduction (mean: 144/88 mm Hg) and glucose control (mean HgbA1c = 7.0%) reduced stroke, microvascular outcomes, death, and all diabetes end points [103], [104]. Although blood pressure control (even with a blood pressure reduction less than that recommended by Joint National Committee [JNC] VI and American Diabetes Association [ADA]
Summary
Diabetic cardiomyopathy encompasses the spectrum from subclinical disease to the full-blown syndrome of congestive heart failure. The prevalence of type 2 diabetes mellitus is increasing at an alarming rate in the western world, and with it, the frequency of diabetes-related heart failure. There is at least early suggestion that target-driven, long-term, intensified intervention that is aimed at multiple risk factors in patients who have type 2 diabetes and microalbuminuria may reduce the risk
References (140)
- et al.
Heart failure in diabetic patients: utility of beta-blockade
J Card Fail
(2003) - et al.
Impaired vascular reactivity in insulin-dependent diabetes mellitus is related to disease duration and low density lipoprotein cholesterol levels
J Am Coll Cardiol
(1996) - et al.
Vascular function and carotid intimal-medial thickness in children with insulin-dependent diabetes mellitus
J Amer Coll Cardiol
(2003) - et al.
Modulation of cardiac Ca2+ channels in Xenopus oocytes by protein kinase C
FEBS Lett
(1992) Initiation of acute phase response and synthesis of cytokines
Biochim Biophys Acta
(1996)- et al.
Regulation of angiotensin converting enzyme activity in cultured human vascular endothelial cells
Biochem Biophys Res Commun
(1987) - et al.
NF-kappa B: ten years after
Cell
(1996) - et al.
Angiotensin II induces expression of the cfos gene through protein kinase c activation and calcium ion mobilization in cultured vascular smooth muscle cells
Biochem Biophys Res Commun
(1988) - et al.
Streptozotocin-induced changes in cardiac gene expression in the absence of severe contractile dysfunction
J Mol Cell Cardiol
(2000) - et al.
Reactivation of peroxisome proliferators-activated receptor alpha is associated with contractile dysfunction in hypertrophied rat heart
J Biol Chem
(2001)
Molecular mechanisms underlying the long-term impact of dietary fat to increase cardiac pyruvate dehydrogenase kinase. Regulation by insulin, cyclic AMP and pyruvate
J Mol Cell Cardiol
Insulin resistance and hyperinsulinemia in patients with chronic congestive heart failure
Metabolism
Prognostic importance of insulin-mediated glucose uptake in aged patients with congestive heart failure secondary to mitral and/or aortic valve disease
Am J Cardiol
Insulin resistance in chronic heart failure: relation to severity and etiology of heart failure
J Am Coll Cardiol
Differentiation of the metabolic and vascular effects of insulin in insulin resistance in patients with chronic heart failure
Am J Cardiol
Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study
Lancet
Insulin, proinsulin, proinsulin:insulin ratio, and the risk of developing type 2 diabetes mellitus in women
Am J Med
Myocardial alterations in diabetes and hypertension
Diab Res Clin Practice
Albuminuria as a predictor of heart failure hospitalizations in patients with type 2 diabetes
J Card Fail
Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis
J Am Coll Cardiol
Diabetes and hypertensive vascular disease. Mechanisms and treatment
Am J Cardiol
New type of cardiomyopathy associated with diabetic glomerulosclerosis
Am J Cardiol
Diabetic cardiomyopathy
Am Heart J
Clinically unrecognized ventricular dysfunction in young diabetic patients
J Am Coll Cardiol
Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy)
Am J Cardiol
Myocardial mechanics in young adult patients with diabetes mellitus: effects of altered load, inotropic state and dynamic exercise
J Am Coll Cardiol
Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus
Am J Cardiol
The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive adults: the Strong Heart Study
JACC
Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography
J Am Coll Cardiol
Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type I (insulin-dependent) diabetic patients
Am J Cardiol
Diastolic dysfunction is associated with altered myocardial metabolism in asymptomatic normotensive patients with well-controlled type 2 diabetes mellitus
J Am Coll Cardiol
Echocardiographic detection of early diabetic myocardial disease
J Am Coll Cardiol
Patients with early diabetic heart disease demonstrate a normal myocardial response to dobutamine
J Am Coll Cardiol
Diabetic cardiomyopathy: the importance of being earliest
J Am Coll Cardiol
Atherosclerosis of the aorta and coronary vessels of the heart in cases of various diseases
J Atheroscler Res
Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview
Lancet
Diabetes and cardiovascular disease: the Framingham Study
JAMA
Obesity and heart failure—risk factor or mechanism?
N Engl J Med
Diabetes, hypertension, and cardiovascular disease: an update
Hypertension
Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study
BMJ
Diabetes mellitus and heart failure
Am Heart Hosp J
Congestive heart failure predicts the development of non-insulin-dependent diabetes mellitus in the elderly. The Osservatorio Geriatrico Regione Campania Group
Diabetes Metab
Adaptation and maladaptation of the heart in diabetes: Part I. General concepts
Circulation
Myocardial disease in hypertensive-diabetic patients
Am J Cardiol
Intensive blood-glucose control with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)
Lancet
Mortality trends and causes of death in diabetic patients
Diabet Metab
Cardiac consequences of diabetes mellitus
Clin Cardiol
Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model
Circulation
Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging
Diabetes
Carotid artery intima-media thickness in children with type 1 diabetes
Diabetes
Cited by (39)
Sorcin ablation plus β-adrenergic stimulation generate an arrhythmogenic substrate in mouse ventricular myocytes
2018, Journal of Molecular and Cellular CardiologyCitation Excerpt :Second, sorcin is encoded by a single gene (Sri) and expressed in several tissues, therefore, it is possible that the cardiac arrhythmias or the decreased lifespan of sorcin KO mice reported here may have extra-cardiac origins. For example, we previously reported that the absence of sorcin in pancreatic β-cells triggers ER stress [8], and it is possible that the resultant glucose intolerance may have impacted cardiac function [38]. Even though our experiments using isolated, Langendorff-perfused hearts indicate that cardiac arrhythmias are present in the absence of autonomic nerve system or hormonal input, we cannot completely discard this possibility.
Cardiac Dysfunction and Heart Failure in Hematopoietic Cell Transplantation Survivors: Emerging Paradigms in Pathophysiology, Screening, and Prevention
2017, Heart Failure ClinicsCitation Excerpt :In animal models, there is evidence that hypertension may accelerate cardiac left ventricular injury after anthracycline exposure.43 The pathophysiology of heart failure in patients with diabetes is more complex, and can be owing to ischemic heart disease or metabolic derangement from chronic hyperglycemia.44 In a large cohort study34 of HCT survivors treated with high-dose (≥250 mg/m2) anthracyclines, the presence of hypertension was associated with a 35-fold increased risk of heart failure, whereas the risk was nearly 27-fold for survivors who developed diabetes, suggesting that hypertension and diabetes may be critical modifiers of cardiac injury after HCT and these at-risk populations to potentially target for aggressive intervention.
The metabolic syndrome predicts incident congestive heart failure: A 20-year follow-up study of elderly finns
2010, AtherosclerosisCitation Excerpt :Hypertension and coronary heart disease (CHD) are considered to be the main causes of CHF. Other established risk factors for CHF are left ventricular hypertrophy (LVH), valvular heart disease, diabetes, cigarette smoking, obesity and dyslipidemia [1–4]. The metabolic syndrome (MetS), a clustering of cardiovascular risk factors conferring an increased risk of cardiovascular disease (CVD), has been defined by a variety of organizations, including the World Health Organization (WHO) in 1999 [5], the European Group for the Study of Insulin Resistance (EGIR) in 1999 [6], the National Cholesterol Education Program (NCEP) Expert Panel in 2001 [7], American College of Endocrinology (ACE) in 2003 [8], the International Diabetes Federation (IDF) in 2005 [9], and the American Heart Association and the National Heart, Lung, and Blood Institute (AHA criteria) in 2005 [10].
Heart Failure in Diabetes and Related Conditions
2007, Journal of Cardiac FailureThe epidemiology of congestive heart failure in hyperglycemia below the threshold for diabetes: A critical review
2007, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :CHF is an often-overlooked complication of diabetes [7] despite being two to eight times (depending on age) more prevalent in patients with diabetes than in the general population of similar age and sex [8]. The literature on the etiology, prevalence, and incidence of CHF in diabetes has been extensively reviewed elsewhere [7,9], so here we only briefly recap this relationship. An increased risk of CHF among patients with diabetes was reported by the Framingham Heart Study over 30 years ago [10].