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Heart 97:774-780 doi:10.1136/hrt.2009.183624
  • Education in Heart
  • Heart failure

Diabetes: a driver for heart failure

  1. Iwan C C van der Horst
  1. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Professor Adriaan A Voors, Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, Groningen, The Netherlands; a.a.voors{at}thorax.umcg.nl

Diabetes and heart failure (HF) often co-exist, and since the number of people with either diabetes or HF is increasing worldwide, the number of diabetic HF patients is expected to grow exponentially. Patients with diabetes and HF have a poorer clinical outcome compared to diabetic patients without HF. Also, HF patients with diabetes have different characteristics compared to HF patients without diabetes. This observation suggests that diabetes might contribute to the onset and progression of HF. Several other findings support the concept that diabetes is a driver for HF. Diabetes might increase the risk of developing HF through the increased risk of atherosclerotic disease. In addition, diabetes directly influences function and structure of the heart—for example, through altered insulin signalling and mitochondrial dysfunction, increased (deposition of) advanced glycation end products (AGEs), oxidative stress, and lipid accumulation. Several treatment guidelines exist for diabetes and HF, but the specific treatment suggestions for diabetics with HF are sparse. Moreover, some treatment options for diabetes are not recommended for those with concomitant HF. This article provides an overview of the current knowledge and understanding regarding the epidemiology, pathophysiology, and treatment of patients with HF and diabetes.

Epidemiology, clinical characteristics, and outcome of HF patients with diabetes

Prevalence of HF in patients with diabetes

In the general population the prevalence of patients with both HF and diabetes is estimated at 0.5% in men and 0.4% in women.1 In patients with diabetes the prevalence of HF is between 9–22%, which is much higher compared to the general population. In a hospital discharge database of the Kaiser Permanente Northwest Division the prevalence of HF was 11.8% in patients with diabetes compared to 4.5% in patients without diabetes (n=1566).w1 The prevalence is highest in women aged 70 years and older.w2 The prevalence of asymptomatic diastolic dysfunction in patients with diabetes is probably higher, and estimated to be between 52–60%.w3 w4 Not all …