Diabetes Mellitus and Heart Failure

Dinesh Jagasia, MBBS, Patrick H. McNulty, MD

CHF. 2003;9(3) 

In This Article

Summary

Patients with type 2 diabetes mellitus develop CHF more frequently than their peers without diabetes, more frequently progress to cardiac death, and exhibit abnormal myocardial systolic and diastolic function even when clinically healthy. A large body of epidemiologic, clinical, and experimental data suggest these observations may reflect a specific cardiomyopathy of diabetes, in which diabetes itself synergizes with the frequently associated conditions of hypertension, obesity, and high-fat and high-calorie consumption to produce pathologic alterations in myocardial metabolism, structure, and function. The search for pathophysiologic mechanisms linking diabetes and heart failure has now broadened to include not only the study of myocardial energy metabolism, but also consideration of the potential effects of excess glucose and fat availability on intracellular signaling, gene transcription, and cell cycle regulation in cardiomyocytes and endothelial cells. These considerations seem likely to stimulate interest in future clinical trials testing the effects of tight glucose and FFA control on the incidence and rate of progression of heart failure in patients with diabetes and cardiovascular disease.

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