Title:Type 2 Diabetes and Heart Failure: Challenges and Solutions
Volume: 12
Issue: 3
Author(s): Merlin C. Thomas
Affiliation:
Keywords:
Diabetes, diabetic cardiomyopathy, diastolic dysfunction, heart failure, congestive cardiac failure.
Abstract: Increasing numbers of older patients with type 2 diabetes, and their
improved survival from cardiovascular events is seeing a massive increase in patients
with both diabetes and heart failure. Already, at least a third of all patients
with heart failure have diabetes. This close association is partly because all the
major risk factors for heart failure also cluster in patients with type 2 diabetes,
including obesity, hypertension, advanced age, sleep apnoea, dyslipidaemia,
anaemia, chronic kidney disease, and coronary heart disease. However, diabetes
may also cause cardiac dysfunction in the absence of overt macrovascular disease,
as well as complicate the response to therapy. Current management is focused on
targeting modifiable risk factors for heart failure including hyperglycaemia,
dyslipidaemia, hypertension, obesity and anemia. But although these are important risk markers,
none of these interventions substantially prevents heart failure or improves its outcomes. Much more
needs to be done to focus on this issue, including the inclusion of hospital admission for heart failure
as a pre-specified component of the primary composite cardiovascular outcomes and new trials in
heart failure management specifically in the context of diabetes.
