Endocrinology and Metabolism Clinics of North America
CARDIOMYOPATHY AND HEART FAILURE IN DIABETES
Section snippets
IMPACT OF CARDIOMYOPATHY AND HEART FAILURE IN DIABETES
The syndrome of heart failure is the clinical manifestation of the final common pathway of most end-stage cardiovascular complications. Community-based studies have confirmed the substantial cardiovascular burden in the rapidly growing diabetic population47, 68and therefore demonstrated a remarkable increase in patients with the dual diagnoses of heart failure and diabetes mellitus. Overall, diabetes is observed in approximately 15% to 25% of heart failure patients in population-based studies
HEART FAILURE CAUSED BY ISCHEMIC CARDIOMYOPATHY IN DIABETES
Few would doubt the importance of diabetes as an independent risk factor for coronary artery disease. Even in its asymptomatic form, coronary artery disease is still believed to be more common and often more extensive in diabetic patients. In the 7-year follow-up of the San Antonio Heart Study, patients with diabetes with no history of coronary artery diseases were found to have as high a risk of acute myocardial infarction as those with a prior history of myocardial infarction (20.2% versus
HEART FAILURE CAUSED BY NONISCHEMIC CARDIOMYOPATHY IN DIABETES
Although coronary artery disease may contribute to the development of heart failure in a proportion of diabetic patients, some patients do not have obvious ischemic insults that lead to progressive heart failure. In the clinical setting, every 1% increase in the baseline glycosylated hemoglobin level translates into a 15% increase in risk of developing heart failure.14 On the other hand, a number of early autopsy studies have challenged the notion that diabetic patients may have more diffuse
MANAGEMENT OF CARDIOMYOPATHY AND HEART FAILURE IN DIABETES
The management of patients with concomitant heart failure and diabetes follows the same general approach used in treating heart failure and diabetes separately. Although clinical trials have provided a wealth of information regarding the efficacies of various treatment options for either heart failure or diabetes, there is a limited understanding of the optimal combined therapy for both diseases. Special considerations should be made to reduce polypharmacy and to watch meticulously for adverse
SUMMARY
Patients with insulin resistance or type 2 diabetes have a particularly high risk for heart failure and a poor prognosis once they develop heart failure. The choice of drugs for the management of heart failure in these patients should be directed at changing the natural history of the disease. The various drugs available for the treatment of heart failure, including ACE inhibitors and β-adrenergic blockers, are known to be beneficial and should be given as first-line agents. Aggressive
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Cited by (21)
Diabetes triggers a PARP1 mediated death pathway in the heart through participation of FoxO1
2012, Journal of Molecular and Cellular CardiologyCitation Excerpt :Previously, we and others have extensively documented evidence of a specific impairment of heart muscle in an animal model of type 1 (STZ-induced) diabetes [10]. This disorder, termed ‘diabetic cardiomyopathy’, is usually evident following prolonged hyperglycemia, but is likely an outcome of early changes in a) metabolism, b) subcellular organelles which control ion movements, specifically intracellular calcium, and c) cell death [3,10,47]. Given that hearts from patients with diabetes have increased myocardial apoptotic and necrotic cell death [3], our data suggest that by regulating the FoxO1-iNOS pathway, we could potentially impede cardiac cell death associated with diabetes, and hence prevent or delay diabetic cardiomyopathy (Fig. 7).
Heart failure
2005, LancetCitation Excerpt :Whether persisting systolic dysfunction is caused by coronary-artery disease in the absence of infarction is uncertain, as is the corollary—ie, whether reversal of ischaemia and “hibernation” improves systolic function.45 The contribution of diabetes to systolic and diastolic dysfunction needs to be elucidated more fully, as does the relation between atrial fibrillation and both types of heart failure.46,47 The progression of left-ventricular systolic dysfunction, and the heart-failure syndrome, owing to “remodelling” (as a result of loss of myocytes and maladaptive changes in the surviving myocytes and extracellular matrix), probably occurs in two main ways.48–51
Should We Be Evaluating the Ventricle or the Myocardium? Advances in Tissue Characterization
2004, Journal of the American Society of EchocardiographyCardioproteomics: Insights on Cardiovascular Diseases
2024, Advances in Experimental Medicine and BiologyDeletion of rasGRF1 attenuated interstitial fibrosis in streptozotocin-induced diabetic cardiomyopathy in mice through affecting inflammation and oxidative stress
2018, International Journal of Molecular SciencesMyocardial functional abnormalities and serum N-terminal pro-brain natriuretic peptide in type II diabetes mellitus patients with cardiovascular autonomic neuropathy
2017, International Journal of Diabetes in Developing Countries
Address reprint requests to James B. Young, MD Department of Cardiology Cleveland Clinic Foundation 9500 Euclid Avenue, Desk F25 Cleveland, OH 44195 e-mail: [email protected]