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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

Survival in patients with multivessel CAD treated by CABG or PTCA according to presence/absence of diabetes mellitus and left ventricular dysfunction at baseline. Adapted from the BARI study [90]. In the diabetes mellitus (DM) subgroup, the outcome was better in the CABG group than in the PTCA group; this holds true in the presence or in the absence of left ventricular dysfunction.
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Figure 9: Survival in patients with multivessel CAD treated by CABG or PTCA according to presence/absence of diabetes mellitus and left ventricular dysfunction at baseline. Adapted from the BARI study [90]. In the diabetes mellitus (DM) subgroup, the outcome was better in the CABG group than in the PTCA group; this holds true in the presence or in the absence of left ventricular dysfunction.

Mentions: Patients with ischemic cardiomyopathy represent an important subset of HF patients in whom myocardial revascularization may offer the potential for reduced symptoms and enhanced prognosis [80-84]. The optimal therapeutic strategy for coronary revascularization of diabetic patients is still a matter of debate [85-90]. Limited data are available regarding the relative merits of Coronary Artery Bypass Grafting (CABG) versus Percutaneous Transluminal Coronary Angioplasty (PTCA) in diabetic patients with ischemic HF: in a recent report of the Bypass Angioplasty Revascularization Investigation (BARI) study, the 7-year mortality was compared in patients randomized to CABG or PTCA according to the presence or absence of diabetes mellitus and left ventricular dysfunction at baseline [90]. In non-diabetic patients with left ventricular dysfunction the 7-year survival was similar in the CABG group and the PTCA group; on the other hand, in diabetic patients with left ventricular dysfunction CABG was associated with a better outcome than PTCA (Figure 9). Although these results support the choice of CABG as revascularization technique for diabetic patients with left ventricular dysfunction and multivessel coronary artery disease, it must be noted that patient selection and inclusion in the BARI study was performed >10 years ago [85]. Since then, new modalities of myocardial revascularization have been developed; the generalisation of the use of arterial grafts [85] and of coronary stent implantation [91,92], and the advent of IIb/IIIa antagonists [93,94] all have the potential to improve the outcome of diabetic HF patients undergoing myocardial revascularization. Similarly, the recent demonstration that drug eluting stents may significantly reduce the risk of restenosis could have a major impact in diabetic HF patients undergoing percutaneous coronary revascularization [95].


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)

Survival in patients with multivessel CAD treated by CABG or PTCA according to presence/absence of diabetes mellitus and left ventricular dysfunction at baseline. Adapted from the BARI study [90]. In the diabetes mellitus (DM) subgroup, the outcome was better in the CABG group than in the PTCA group; this holds true in the presence or in the absence of left ventricular dysfunction.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 9: Survival in patients with multivessel CAD treated by CABG or PTCA according to presence/absence of diabetes mellitus and left ventricular dysfunction at baseline. Adapted from the BARI study [90]. In the diabetes mellitus (DM) subgroup, the outcome was better in the CABG group than in the PTCA group; this holds true in the presence or in the absence of left ventricular dysfunction.
Mentions: Patients with ischemic cardiomyopathy represent an important subset of HF patients in whom myocardial revascularization may offer the potential for reduced symptoms and enhanced prognosis [80-84]. The optimal therapeutic strategy for coronary revascularization of diabetic patients is still a matter of debate [85-90]. Limited data are available regarding the relative merits of Coronary Artery Bypass Grafting (CABG) versus Percutaneous Transluminal Coronary Angioplasty (PTCA) in diabetic patients with ischemic HF: in a recent report of the Bypass Angioplasty Revascularization Investigation (BARI) study, the 7-year mortality was compared in patients randomized to CABG or PTCA according to the presence or absence of diabetes mellitus and left ventricular dysfunction at baseline [90]. In non-diabetic patients with left ventricular dysfunction the 7-year survival was similar in the CABG group and the PTCA group; on the other hand, in diabetic patients with left ventricular dysfunction CABG was associated with a better outcome than PTCA (Figure 9). Although these results support the choice of CABG as revascularization technique for diabetic patients with left ventricular dysfunction and multivessel coronary artery disease, it must be noted that patient selection and inclusion in the BARI study was performed >10 years ago [85]. Since then, new modalities of myocardial revascularization have been developed; the generalisation of the use of arterial grafts [85] and of coronary stent implantation [91,92], and the advent of IIb/IIIa antagonists [93,94] all have the potential to improve the outcome of diabetic HF patients undergoing myocardial revascularization. Similarly, the recent demonstration that drug eluting stents may significantly reduce the risk of restenosis could have a major impact in diabetic HF patients undergoing percutaneous coronary revascularization [95].

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