J Korean Diabetes.  2019 Mar;20(1):1-5. 10.4093/jkd.2019.20.1.1.

Heart Failure: Complications of Type 2 Diabetes

• Seol SH

• KMID: 2442346
• DOI: http://doi.org/10.4093/jkd.2019.20.1.1

Abstract

There is a close relationship between diabetes mellitus and heart failure, both of which are known to increase morbidity and mortality. Diabetes can cause or aggravate heart failure, and heart failure can precipitate diabetes. Diabetes mellitus causes structural and functional changes in the heart, such as fibrosis of the myocardium and left ventricular dysfunction. The mechanisms of diabetic cardiomyopathy are metabolic disturbance, myocardial fibrosis, microvascular disease, and autonomic dysfunction. Improper blood glucose control leads to deterioration of heart failure, but the role of strict glycemic control in reducing heart failure is unclear. The role of SGLT2 inhibitors in reducing the incidence of heart failure is of great importance in the treatment of diabetic patients. However, further long-term follow-up and safety studies are needed.

Keyword

Diabetes complication; Heart failure

MeSH Terms

Blood Glucose
Diabetes Complications
Diabetes Mellitus
Diabetic Cardiomyopathies
Fibrosis
Follow-Up Studies
Heart Failure*
Heart*
Humans
Incidence
Mortality
Myocardium
Ventricular Dysfunction, Left
Blood Glucose

Figure

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  Fig. 1. Pathophysiological mechanisms of diabetes mellitus and heart failure. Adapted from the article of Lee and Kim. (Korean J Intern Med 2017;32:404-21) [5] with original copyright holder permission. RAAS, renin-angiotensin-aldosterone system; AGE, advanced glycation end product; FA, fatty acid; TGF-β, transforming growth factor-β.

Reference

1.Rydén L., Armstrong PW., Cleland JG., Horowitz JD., Massie BM., Packer M., Poole-Wilson PA. Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial. Eur Heart J. 2000. 21:1967–78.

2.Kannel WB., Hjortland M., Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974. 34:29–34.

3.Wang Y., Negishi T., Negishi K., Marwick TH. Prediction of heart failure in patients with type 2 diabetes mellitus-a systematic review and meta-analysis. Diabetes Res Clin Pract. 2015. 108:55–66.

4.Cubbon RM., Adams B., Rajwani A., Mercer BN., Patel PA., Gherardi G., Gale CP., Batin PD., Ajjan R., Kearney L., Wheatcroft SB., Sapsford RJ., Witte KK., Kearney MT. Diabetes mellitus is associated with adverse prognosis in chronic heart failure of ischaemic and non-ischaemic aetiology. Diab Vasc Dis Res. 2013. 10:330–6.

5.Lee WS., Kim J. Diabetic cardiomyopathy: where we are and where we are going. Korean J Intern Med. 2017. 32:404–21.

6.Fang ZY., Prins JB., Marwick TH. Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocr Rev. 2004. 25:543–67.

7.Epshteyn V., Morrison K., Krishnaswamy P., Kazanegra R., Clopton P., Mudaliar S., Edelman S., Henry R., Maisel A. Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes. Diabetes Care. 2003. 26:2081–7.

8.Ponikowski P., Voors AA., Anker SD., Bueno H., Cleland JGF., Coats AJS., Falk V., González-Juanatey JR., Harjola VP., Jankowska EA., Jessup M., Linde C., Nihoyannopoulos P., Parissis JT., Pieske B., Riley JP., Rosano GMC., Ruilope LM., Ruschitzka F., Rutten FH., van der Meer P. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Rev Esp Cardiol (Engl Ed). 2016. 69:1167.

9.Scirica BM., Braunwald E., Raz I., Cavender MA., Morrow DA., Jarolim P., Udell JA., Mosenzon O., Im K., Umez-Eronini AA., Pollack PS., Hirshberg B., Frederich R., Lewis BS., McGuire DK., Davidson J., Steg PG., Bhatt DL. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation. 2015. 132:e198.

10.White WB., Cannon CP., Heller SR., Nissen SE., Bergenstal RM., Bakris GL., Perez AT., Fleck PR., Mehta CR., Kupfer S., Wilson C., Cushman WC., Zannad F. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013. 369:1327–35.

11.Green JB., Bethel MA., Armstrong PW., Buse JB., Engel SS., Garg J., Josse R., Kaufman KD., Koglin J., Korn S., Lachin JM., McGuire DK., Pencina MJ., Standl E., Stein PP., Suryawanshi S., Van de Werf F., Peterson ED., Holman RR. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015. 373:232–42.

12.McGuire DK., Alexander JH., Johansen OE., Perkovic V., Rosenstock J., Cooper ME., Wanner C., Kahn SE., Toto RD., Zinman B., Baanstra D., Pfarr E., Schnaidt S., Meinicke T., George JT., von Eynatten M., Marx N. CARMELINA Investigators. Linagliptin effects on heart failure and related outcomes in individuals with type 2 diabetes mellitus at high cardiovascular and renal risk in CARMELINA. Circulation. 2019. 139:351–61.

13.Marso SP., Daniels GH., Brown-Frandsen K., Kristensen P., Mann JF., Nauck MA., Nissen SE., Pocock S., Poulter NR., Ravn LS., Steinberg WM., Stockner M., Zinman B., Bergenstal RM., Buse JB. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016. 375:311–22.

14.Zinman B., Wanner C., Lachin JM., Fitchett D., Bluhmki E., Hantel S., Mattheus M., Devins T., Johansen OE., Woerle HJ., Broedl UC., Inzucchi SE. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015. 373:2117–28.

15.Neal B., Perkovic V., Mahaffey KW., de Zeeuw D., Fulcher G., Erondu N., Shaw W., Law G., Desai M., Matthews DR. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017. 377:644–57.

16.Wiviott SD., Raz I., Bonaca MP., Mosenzon O., Kato ET., Cahn A., Silverman MG., Zelniker TA., Kuder JF., Murphy SA., Bhatt DL., Leiter LA., McGuire DK., Wilding JPH., Ruff CT., Gause-Nilsson IAM., Fredriksson M., Johansson PA., Langkilde AM., Sabatine MS. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019. 380:347–57.