Diabetes mellitus and heart failure – fatal attraction

Authors: Eva Gonçalvesová
Authors‘ workplace: Národný ústav srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika
Published in: Forum Diab 2019; 8(2): 99-104


Concerns relating to cardiovascular disease associated with type 2 diabetes mellitus (T2DM) are traditionally focused on atherosclerotic vascular-occlusive events, such as myocardial infarction, stroke and limb ischemia. However one of the most frequently occurring and serious cardiovascular disorders in patients with diabetes is heart failure (HF) Patients with diabetes have a threefold increased risk of developing HF, with a substantially higher risk (up to fivefold) being present in women with diabetes. After the clinical manifestation of HF in a patient with diabetes, his/her prognosis is dramatically worse than that of a diabetic without HF. Some surveys show that mortality within a year’s time following HF manifestation is almost nine times higher in diabetic patients over the age of 65 than in comparable individuals without diabetes. A role in the development of HF is often played by the present arterial hypertension, coronary disease and metabolic disorders resulting from diabetes itself. Thus, we can talk about heart damage by diabetes in general. Pharmacological treatment of diabetic patients with HF as well as non-diabetics is approached equally today. Consistent control of blood glucose and other risk factors of cardiovascular diseases reduces the risk of developing HF in diabetics. In patients with T2DM who have developed HF, the strategy of strict control of diabetes does not any more bring about a reduction in the risk of death or other cardiovascular events. In patients with T2DM and the risk of developing HF (patients with hypertension and/or those who have overcome myocardial infarction), the treatment using SGLT2 inhibitors reduces the risk of death from cardiovascular causes, onset of and hospitalization for HF. Most other antidiabetic drugs have a negative impact on HF. The selection of antidiabetic agents for these patients should be consistent with current evidence-based medicine and should keep to the procedures with proven benefits for survival and cardiovascular risks.



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