Early Failure of the Diabetic Heart
- Ida Gustafsson, MD and
- Per Hildebrandt, MD, DMSCI
- From Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Copenhagen, Denmark.
- Address correspondence to Per Hildebrandt, MD, DMSci, Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Ndr. Fasanvej 57 DK-2000 Frederiksberg, Denmark. E-mail: ph{at}fh.hosp.dk .
That diabetes is a risk factor for congestive heart failure has been established for decades, but knowledge of the pathophysiology and treatment of heart failure in diabetes is limited. The prevalence of diabetes in different surveys and clinical trials of heart failure ranges from 10 to > 30% (1). In the community setting, data from the Framingham Heart Study have shown an increased incidence of congestive heart failure in diabetic subjects irrespective of coronary heart disease and hypertension (2). The relative impact of diabetes on developing heart failure was found to be greater in women. In the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry, diabetes was found to be an independent risk factor for mortality and morbidity in both symptomatic and asymptomatic heart failure (3). A common finding in diabetic patients enrolled in clinical trials of myocardial infarction is a discrepancy between left ventricular systolic function and heart failure symptoms (4,5). Despite similar left ventricular systolic function, patients with diabetes have more pronounced heart failure symptoms, use more diuretics, and have an adverse prognosis compared with those without diabetes. One putative explanation for this discrepancy is diastolic dysfunction of the left ventricle.
In over heart failure, diastolic dysfunction often coexists with systolic dysfunction as a consequence of ischemic …
