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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

Diabetes mellitus as a predictor of clinical outcome in HF populations. All cause mortality and cardiovascular mortality are higher in diabetics than in nondiabetics. Adapted from the SOLVD trials [17].
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Figure 7: Diabetes mellitus as a predictor of clinical outcome in HF populations. All cause mortality and cardiovascular mortality are higher in diabetics than in nondiabetics. Adapted from the SOLVD trials [17].

Mentions: The first suggestion that DM may be a predictor of poor clinical outcome in HF patients came in a report from Shindler et al [17]. A subgroup analysis of the SOLVD trials (combining the Prevention and the Treatment trials), showed that both all cause mortality and cardiovascular mortality at a mean follow-up of 3 years were significantly higher in diabetic patients than in non-diabetic patients (Figure 7). Multivariate analysis was used to assess the significance of DM as an independent predictor of outcome. After adjusting for important baseline variables such as age, sex, NYHA classification, or left ventricular ejection fraction, DM remained a significant predictor of clinical outcome in both the Prevention and the Treatment trials. More recently, Dries et al reanalyzed the SOLVD database to determine whether DM would have a different impact on clinical outcome in ischemic versus non-ischemic HF [27]. After adjustment for baseline variables, they found that DM was associated with an increased risk for all-cause mortality in patients with ischemic HF (RR 1.37, 95% CI 1.21 to 1.55), but not in patients with non-ischemic HF (RR 0.98, 95% CI 0.76 to 1.32) (Figure 8). Moreover, they suggested that the increased mortality in patients with ischemic HF compared with non-ischemic HF (reviewed in [63]) may be limited to the diabetic subgroup. If these findings are confirmed in independent studies, at least two explanations may account for the negative interaction between DM and the ischemic etiology of heart failure. Firstly, diabetic HF patients may have a higher risk of coronary plaque rupture and thrombosis [29,64]; recurrent myocardial infarction is a major cause of death in patients with ischemic HF [65]; in addition, non fatal myocardial infarction may further deteriorate left ventricular function in patients with ischemic HF. Furthermore, the presence of various components of a specific diabetic cardiomyopathy such as impaired myocardial glucose uptake may be especially deleterious in patients with ischemic HF [66-69].


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)

Diabetes mellitus as a predictor of clinical outcome in HF populations. All cause mortality and cardiovascular mortality are higher in diabetics than in nondiabetics. Adapted from the SOLVD trials [17].
© Copyright Policy
Related In: Results  -  Collection

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

Figure 7: Diabetes mellitus as a predictor of clinical outcome in HF populations. All cause mortality and cardiovascular mortality are higher in diabetics than in nondiabetics. Adapted from the SOLVD trials [17].
Mentions: The first suggestion that DM may be a predictor of poor clinical outcome in HF patients came in a report from Shindler et al [17]. A subgroup analysis of the SOLVD trials (combining the Prevention and the Treatment trials), showed that both all cause mortality and cardiovascular mortality at a mean follow-up of 3 years were significantly higher in diabetic patients than in non-diabetic patients (Figure 7). Multivariate analysis was used to assess the significance of DM as an independent predictor of outcome. After adjusting for important baseline variables such as age, sex, NYHA classification, or left ventricular ejection fraction, DM remained a significant predictor of clinical outcome in both the Prevention and the Treatment trials. More recently, Dries et al reanalyzed the SOLVD database to determine whether DM would have a different impact on clinical outcome in ischemic versus non-ischemic HF [27]. After adjustment for baseline variables, they found that DM was associated with an increased risk for all-cause mortality in patients with ischemic HF (RR 1.37, 95% CI 1.21 to 1.55), but not in patients with non-ischemic HF (RR 0.98, 95% CI 0.76 to 1.32) (Figure 8). Moreover, they suggested that the increased mortality in patients with ischemic HF compared with non-ischemic HF (reviewed in [63]) may be limited to the diabetic subgroup. If these findings are confirmed in independent studies, at least two explanations may account for the negative interaction between DM and the ischemic etiology of heart failure. Firstly, diabetic HF patients may have a higher risk of coronary plaque rupture and thrombosis [29,64]; recurrent myocardial infarction is a major cause of death in patients with ischemic HF [65]; in addition, non fatal myocardial infarction may further deteriorate left ventricular function in patients with ischemic HF. Furthermore, the presence of various components of a specific diabetic cardiomyopathy such as impaired myocardial glucose uptake may be especially deleterious in patients with ischemic HF [66-69].

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