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Influence of diabetes mellitus on heart failure risk and outcome.

Bauters C, Lamblin N, Mc Fadden EP, Van Belle E, Millaire A, de Groote P - Cardiovasc Diabetol (2003)

Bottom Line: Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis.Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations.However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre Hospitalier Universitaire de Lille, Place de Verdun, 59037 Lille cedex, France. cbauters@chru-lille.fr

ABSTRACT
Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure. THE STUDIES LINKING DIABETES MELLITUS (DM) WITH HEART FAILURE (HF) : The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy. TREATMENT OF HEART FAILURE IN DIABETIC PATIENTS : The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients.

No MeSH data available.


Related in: MedlinePlus

Incidence of HF and coronary artery disease (CAD) as a function of diabetes mellitus in general populations. The rates of both HF (Fig 3A) and CAD (Fig 3B) are higher in diabetics. The relative risks are higher for women than for men. Adapted from reference [11].
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Figure 3: Incidence of HF and coronary artery disease (CAD) as a function of diabetes mellitus in general populations. The rates of both HF (Fig 3A) and CAD (Fig 3B) are higher in diabetics. The relative risks are higher for women than for men. Adapted from reference [11].

Mentions: The first demonstration of an increased risk of HF in patients with DM was reported by Kannel and McGee [11] based on data obtained from 20 years follow-up of the Framingham cohort. The incidence of HF according to sex and diabetic status is shown in Figure 3A; an increased risk of HF was observed in patients with DM. Compared with non-diabetic males and females, the age-adjusted relative risks of HF for diabetic males and females were 2.20 and 5.37, respectively [11]. In a study by Tenenbaum et al in patients with ischemic heart disease, the incidence of HF at 6 to 9-year follow-up was 35.7% in non diabetic patients, 39% in patients with impaired fasting glucose and 45.7% in diabetic patients [21]. Other studies have demonstrated that the incidence of HF in diabetic patients is significantly correlated with HbA1c levels. This was primarily shown in the UK Prospective Diabetes Study (UKPDS) [22] (Figure 4A). These results were confirmed in a large population-based sample of 48,858 diabetic patients [23]; after adjustment for age and sex, each 1% increase in HbA1c was associated with a 12% increased risk of hospitalization for HF and/or death. These data demonstrating a strong association between HbA1c levels and HF in diabetic populations should be interpretated with caution; although poor glycemic control may be an independent risk factor for developing HF in diabetic populations, it is also conceivable that these data simply suggest a longer duration of DM, which is difficult to control, and therefore the development of HF may be more closely related to the duration of DM than to glycemic control.


Influence of diabetes mellitus on heart failure risk and outcome.

Bauters C, Lamblin N, Mc Fadden EP, Van Belle E, Millaire A, de Groote P - Cardiovasc Diabetol (2003)

Incidence of HF and coronary artery disease (CAD) as a function of diabetes mellitus in general populations. The rates of both HF (Fig 3A) and CAD (Fig 3B) are higher in diabetics. The relative risks are higher for women than for men. Adapted from reference [11].
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC149427&req=5

Figure 3: Incidence of HF and coronary artery disease (CAD) as a function of diabetes mellitus in general populations. The rates of both HF (Fig 3A) and CAD (Fig 3B) are higher in diabetics. The relative risks are higher for women than for men. Adapted from reference [11].
Mentions: The first demonstration of an increased risk of HF in patients with DM was reported by Kannel and McGee [11] based on data obtained from 20 years follow-up of the Framingham cohort. The incidence of HF according to sex and diabetic status is shown in Figure 3A; an increased risk of HF was observed in patients with DM. Compared with non-diabetic males and females, the age-adjusted relative risks of HF for diabetic males and females were 2.20 and 5.37, respectively [11]. In a study by Tenenbaum et al in patients with ischemic heart disease, the incidence of HF at 6 to 9-year follow-up was 35.7% in non diabetic patients, 39% in patients with impaired fasting glucose and 45.7% in diabetic patients [21]. Other studies have demonstrated that the incidence of HF in diabetic patients is significantly correlated with HbA1c levels. This was primarily shown in the UK Prospective Diabetes Study (UKPDS) [22] (Figure 4A). These results were confirmed in a large population-based sample of 48,858 diabetic patients [23]; after adjustment for age and sex, each 1% increase in HbA1c was associated with a 12% increased risk of hospitalization for HF and/or death. These data demonstrating a strong association between HbA1c levels and HF in diabetic populations should be interpretated with caution; although poor glycemic control may be an independent risk factor for developing HF in diabetic populations, it is also conceivable that these data simply suggest a longer duration of DM, which is difficult to control, and therefore the development of HF may be more closely related to the duration of DM than to glycemic control.

Bottom Line: Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis.Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations.However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre Hospitalier Universitaire de Lille, Place de Verdun, 59037 Lille cedex, France. cbauters@chru-lille.fr

ABSTRACT
Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure. THE STUDIES LINKING DIABETES MELLITUS (DM) WITH HEART FAILURE (HF) : The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy. TREATMENT OF HEART FAILURE IN DIABETIC PATIENTS : The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients.

No MeSH data available.


Related in: MedlinePlus