Heart failure in diabetes mellitus
- Richard W Nesto, MD
Richard W Nesto, MD
- Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
INTRODUCTION AND DEFINITION
Diabetes mellitus (DM) increases the risk of heart failure (HF) independent of coronary heart disease and hypertension and may cause a cardiomyopathy. The term “diabetic cardiomyopathy” was initially introduced based upon postmortem findings in four diabetic adults who had HF in the absence of coronary heart disease .
Diabetic cardiomyopathy has been defined as ventricular dysfunction that occurs in diabetic patients independent of a recognized cause (eg, coronary heart disease, hypertension) [2,3]. However, the frequency with which this occurs is not well defined and there is some evidence that diabetic cardiomyopathy is uncommon in patients with type 1 diabetes in the era of intensive insulin therapy .
Issues related to HF in diabetic patients will be reviewed here. The prevalence of and risk factors for coronary heart disease among patients with DM and the evaluation and treatment of HF are discussed separately. (See "Prevalence of and risk factors for coronary heart disease in diabetes mellitus" and "Evaluation of the patient with suspected heart failure" and "Overview of the therapy of heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction".)
There is a well-established association between diabetes mellitus (DM) and heart failure (HF) that is partly but not entirely linked to coronary heart disease and hypertension. Associations have also been reported between absolute blood glucose levels, glycemic control, and HF.
Diabetes and HF — The Framingham Study firmly established the epidemiologic link between diabetes and HF . The risk of HF was increased 2.4-fold in men and fivefold in women. Diabetes predicted HF independent of coexisting hypertension or coronary disease. When patients with prior coronary or rheumatic heart disease were excluded, the relative risk of HF remained elevated at 3.8 in diabetic men and 5.5 in diabetic women.
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- INTRODUCTION AND DEFINITION
- Diabetes and HF
- Glycemic control and blood glucose levels
- Functional abnormalities
- DIABETES DRUGS TO USE WITH CAUTION IN HF
- - Major society and FDA guidelines
- - TZD summary
- General considerations
- Role of glycemic control
- Heart transplantation
- Possible prevention with angiotensin inhibition
- SUMMARY AND RECOMMENDATIONS