diabetestalk.net

Diabetes And Heart Failure Ppt

Diabetes Mellitus And Heart Failure

Diabetes Mellitus And Heart Failure

Login or register to view PDF. View eJournal Order reprints Diabetes mellitus and heart failure are two multifaceted entities characterised by high morbidity and mortality. Early epidemiological and prospective studies have observed the frequent co-existence of both conditions. Importantly, diabetes mellitus can precipitate or worsen heart failure due to the accumulation of advanced glycation end products, oxidative stress, inflammatory status impairment, decay of intracellular calcium, changes in microRNAs expression, not to mention atherosclerosis progression and coronary artery disease. Heart failure also impairs glucose metabolism through less well-known mechanisms. Attention must especially be given in the treatment as there are frequently adverse interactions between the two diseases and novel agents against diabetic cardiomyopathy are under investigation. As several missing links still exist in the connection between heart failure and diabetes mellitus we will review, in this article, the most recent data underlying the interaction of them and provide an overview of the most important clinical perspectives. Diabetes mellitus (DM) is a group of diseases characterised by metabolic disturbances with increasing prevalence worldwide.1 Individuals with DM present several detrimental micro- and macrovascular complications such as retinopathy, nephropathy, neuropathy, atherosclerosis and coronary heart disease.2,3 Accordingly, efforts for early diagnosis and appropriate management are of ultimate importance. Despite the emphasis by clinicians in the prompt control of DM several cardiovascular diseases such as hypertension, coronary heart disease, stroke, peripheral vascular disease, etc., have been linked to impaired glucose management.4 Recently, the awareness in the sc Continue reading >>

The Incidence Of Congestive Heart Failure In Type 2 Diabetes

The Incidence Of Congestive Heart Failure In Type 2 Diabetes

An update Abstract OBJECTIVE—The aims of this study were to update previous estimates of the congestive heart failure (CHF) incidence rate in patients with type 2 diabetes, compare it with an age- and sex-matched nondiabetic group, and describe risk factors for developing CHF in diabetic patients over 6 years of follow-up. RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study of 8,231 patients with type 2 diabetes and 8,845 nondiabetic patients of similar age and sex who did not have CHF as of 1 January 1997, following them for up to 72 months to estimate the CHF incidence rate. In the diabetic cohort, we constructed a Cox regression model to identify risk factors for CHF development. RESULTS—Patients with diabetes were much more likely to develop CHF than patients without diabetes (incidence rate 30.9 vs. 12.4 cases per 1,000 person-years, rate ratio 2.5, 95% CI 2.3–2.7). The difference in CHF development rates between persons with and without diabetes was much greater in younger age-groups. In addition to age and ischemic heart disease, poorer glycemic control (hazard ratio 1.32 per percentage point of HbA1c) and greater BMI (1.12 per 2.5 units of BMI) were important predictors of CHF development. CONCLUSIONS—The CHF incidence rate in type 2 diabetes may be much greater than previously believed. Our multivariate results emphasize the importance of controlling modifiable risk factors for CHF, namely hyperglycemia, elevated blood pressure, and obesity. Younger patients may benefit most from risk factor modification. As the leading cause of hospitalization for individuals aged 65 years and older (1), congestive heart failure (CHF) is emerging as a major public health concern. The CHF problem is magnified in individuals with diabetes, in whom inc Continue reading >>

Diabetes And Heart Disease

Diabetes And Heart Disease

Tweet Heart disease is a complication that may affect people with diabetes if their condition is not managed well for a prolonged period of time.. Coronary heart disease is recognized to be the cause of death for 80% of people with diabetes, however, the NHS states that heart attacks are largely preventable. [48] How are heart disease and diabetes linked? People suffering from type 1 and type 2 diabetes are more likely to be at risk from heart attacks, strokes and high blood pressure. Vascular problems, such as poor circulation to the legs and feet, are also more likely to affect diabetes patients. Like diabetes itself, the symptoms of cardiovascular disease may go undetected for years. A Diabetes UK report from 2007 estimates that the risk of cardiovascular disease in people with diabetes is: [1] 5 times higher in middle aged men 8 times higher in women with diabetes. More than half of type 2 diabetes patients will exhibit signs of cardiovascular disease complications at diagnosis. Who does heart disease affect? Many people think that heart disease only affects the middle-aged and elderly. However, serious cardiovascular disease may develop in diabetics before the age of 30. Both type 1 and type 2 diabetics are at greater risk of developing heart disease. What is the cause of heart disease amongst diabetics? Hyperglycemia, which characterises diabetes, in combination with free fatty acids in the blood can change the makeup of blood vessels, and this can lead to cardiovascular disease. The lining of the blood vessels may become thicker, and this in turn can impair blood flow. Heart problems and the possibility of stroke can occur. What symptoms can identify heart disease? The following are common symptoms of heart disease, although this may vary from individual to indiv Continue reading >>

Heart Failure And Nephropathy: Catastrophic And Interrelated Complications Of Diabetes

Heart Failure And Nephropathy: Catastrophic And Interrelated Complications Of Diabetes

Abstract Heart failure (HF) is a major contributor to poor quality of life, a leading cause of hospitalization, and cause of premature death. Both kidney disease and diabetes are major and independent risk factors for the development of heart failure, such that individuals with diabetic nephropathy are at especially high risk. Such patients not only are likely to have coronary artery disease and hypertension but also are likely to have diabetic cardiomyopathy, a distinct pathologic entity that is more closely associated with the microvascular than the macrovascular complications of diabetes. In addition to a better understanding of the epidemiology of HF, advances in noninvasive imaging have highlighted the importance of early cardiac dysfunction in diabetes and the high prevalence of HF with preserved left ventricular systolic function. Although significant renal dysfunction is usually an exclusion criterion in HF trials, diabetes is often a prespecified subgroup so that subanalyses of large multicenter clinical trials do provide some guidance in therapeutic decision-making. However, further therapies for both HF and nephropathy in diabetes clearly are needed, and a number of new therapeutic strategies that target both disorders have already entered the clinical arena. Epidemiology Chronic HF is a major and growing public health problem in industrialized nations. In the United States, for instance, the prevalence of HF was 4.9 million in 2002 and is estimated to reach 10 million by 2007 (4), such that at age 40, there will be an approximate one in five lifetime risk for developing new-onset HF in both men and women (5). Despite the advances in therapy, mortality in HF remains high, with a 5-yr age-adjusted death rate of 59% in men and 45% in women (6). Moreover, in add Continue reading >>

Diabetes, Pre-diabetes And Cardiovascular Diseases Developed With The Easd

Diabetes, Pre-diabetes And Cardiovascular Diseases Developed With The Easd

Preamble Introduction Abnormalities of glucose metabolism and CVD Definition, classification and diagnosis, Epidemiology,screening for disorders of glucose metabolism, disorders of glucose mtabolism and CVD, delaying conversion to type 2 diabetes mellitus, recommendations for diagnosis of disorders of glucose metabolism Molecular basis of cardiovascular disease in diabetes mellitus The CV continuum in DM, pathophysiology of insulin resistance in T2DM, endothelial dysfunction - oxidative stress and vascular inflammation, macrophage dysfunction, atherogenic dyslipidaemia, coagulation and platelet function, diabetic cardiomyopathy, the metabolic syndrome, endothelial progenitor cells & vascular repair, conclusions Cardiovascular risk assessment in patients with dysglycaemia risk scores developed for people with DM, evaluation of CV risk in people with pre-diabetes, risk engines developed for people in diabetes, risk assessment based on biomakers and imaging, gaps in knowledge, recommendations for CV risk assessement in diabetes Prevention of CVD in patients with diabetes Lifetsyle, glucose control, blood pressure, dyslipidaemia, platelet function, multifactorials approaches Management of stable & unstable coroary artery disease in patients with diabetes Optimal medical treatment for patients with chronic coronary artery disease and diabetes, revascularization Heart failure and diabetes Prevalence and incidence of HF in T2DM and T2DM in HF, DM and HF morbidity and mortality, pharmacologycal management of HF in T2DM, non-pharmacoloical therapies for HF in DM, glucose lowering treatment in patients with HF, gaps in knowledge, recommendations for management of HF in diabetes Arrhythmias: atrial fibrillation and sudden cardiac death Diabetes mellitus and atrial fibrillation, su Continue reading >>

Diabetes Mellitus And Heart Failure

Diabetes Mellitus And Heart Failure

Dinesh Jagasia, MBBS, Patrick H. McNulty, MD Type 2 diabetes mellitus substantially increases the lifetime risk of both developing and dying from heart failure. While this appears to be explained in part by the well-known association of diabetes with hypertension, dyslipidemia, and coronary atherosclerosis, additional pathophysiologic mechanisms linking type 2 diabetes and heart failure have recently been suggested. These include the potentially adverse effects of hyperglycemia on endothelial function and redox state, effects of excess circulating glucose and fatty acids on cardiomyocyte ultra-structure, intracellular signaling and gene expression, and the possibility that diabetes may impair recruitment of the myocardial insulin-responsive glucose transport system in response to ischemia. Because many of these putative pathophysiologic mechanisms should be amenable to normalization of the diabetic metabolic milieu, strategies designed to more carefully control circulating levels of glucose and fatty acids might conceivably delay or prevent the development of heart failure. Type 2 diabetes mellitus affects more than 100 million persons worldwide and its prevalence is increasing in both developed and developing countries.[ 1 ] Because type 2 diabetes is a predictable late consequence of sedentary behavior, obesity, and excessive caloric intake -- all common features of modern life -- this trend seems likely to continue. An association between type 2 diabetes and cardiovascular mortality has been apparent for more than a century and is supported by both longitudinal studies[ 2 , 3 ] and registry data.[ 4 ] This association is undoubtedly mediated in large part by the familiar effect of diabetes to accelerate coronary atherosclerosis.[ 5 , 6 ] Thus, acute myocardial infar Continue reading >>

Cardiovascular Disease And Diabetes

Cardiovascular Disease And Diabetes

1. DIABETES AND CARDIOVASCULAR DISEASE DR VISHWANATH HESARUR SENIOR RESIDENT DEPARTMENT OF CARDIOLOGY JNMC , BELGAUM 2. DIABETES MELLITUS  Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.  Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.  Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.  The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system. 3. Classification  DM is classified on the basis of the pathogenic process that leads to hyperglycemia .  The two broad categories of DM are designated type 1 and type 2 Spectrum of glucose homeostasis and DM 4. EPIDEMIOLOGY  The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 30 million cases in 1985 to 285 million in 2010.  The International Diabetes Federation projects that 438 million individuals will have diabetes by the year 2030 Indian  40.9 million people in 2001.  By the year 2025, 80.9 million will have diabetes in India.  There is still inadequate population-based data on the prevalence of CAD in India, particularly comparing diabetic and nondiabetic subjects. 5. CRITERIA FOR THE DIAGNOSIS OF DIABETES MELLITUS  Symptoms of diabetes plus random blood glucose concentration 11.1 mmol/L (200 mg/dL)aor  Fasting plasma glucose 7.0 mmol/L (126 mg/dL)bor  A1C > 6.5%cor  Two-hour plasma glucose 11.1 mmol/L (200 mg/dL) during an oral glucose tolera Continue reading >>

Heart Failure In Diabetes: Effects Of Anti-hyperglycaemic Drug Therapy

Heart Failure In Diabetes: Effects Of Anti-hyperglycaemic Drug Therapy

Summary Individuals with diabetes are not only at high risk of developing heart failure but are also at increased risk of dying from it. Fortunately, antiheart failure therapies such as angiotensin-converting-enzyme inhibitors, β blockers and mineralocorticoid-receptor antagonists work similarly well in individuals with diabetes as in individuals without the disease. Response to intensive glycaemic control and the various classes of antihyperglycaemic agent therapy is substantially less well understood. Insulin, for example, induces sodium retention and thiazolidinediones increase the risk of heart failure. The need for new glucose-lowering drugs to show cardiovascular safety has led to the unexpected finding of an increase in the risk of admission to hospital for heart failure in patients treated with the dipeptidylpeptidase-4 (DPP4) inhibitor, saxagliptin, compared with placebo. Here we review the relation between glycaemic control and heart failure risk, focusing on the state of knowledge for the various types of antihyperglycaemic drugs that are used at present. Continue reading >>

Heart Failure In Diabetes Mellitus

Heart Failure In Diabetes Mellitus

INTRODUCTION AND DEFINITION Diabetes mellitus (DM) increases the risk of heart failure (HF) independent of coronary heart disease and hypertension and may cause a cardiomyopathy. The term “diabetic cardiomyopathy” was initially introduced based upon postmortem findings in four diabetic adults who had HF in the absence of coronary heart disease [1]. Diabetic cardiomyopathy has been defined as ventricular dysfunction that occurs in diabetic patients independent of a recognized cause (eg, coronary heart disease, hypertension) [2,3]. However, the frequency with which this occurs is not well defined and there is some evidence that diabetic cardiomyopathy is uncommon in patients with type 1 diabetes in the era of intensive insulin therapy [4]. Issues related to HF in diabetic patients will be reviewed here. The prevalence of and risk factors for coronary heart disease among patients with DM and the evaluation and treatment of HF are discussed separately. (See "Prevalence of and risk factors for coronary heart disease in diabetes mellitus" and "Evaluation of the patient with suspected heart failure" and "Overview of the therapy of heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction".) EPIDEMIOLOGY There is a well-established association between diabetes mellitus (DM) and heart failure (HF) that is partly but not entirely linked to coronary heart disease and hypertension. Associations have also been reported between absolute blood glucose levels, glycemic control, and HF. Diabetes and HF — The Framingham Study firmly established the epidemiologic link between diabetes and HF [5]. The risk of HF was increased 2.4-fold in men and fivefold in women. Diabetes predicted HF independent of coexisting hypert Continue reading >>

Diabetes And Heart Failure - Us Cardiology Review

Diabetes And Heart Failure - Us Cardiology Review

Heart failure is a global public health problem with high mortality and readmission rates. Race and ethnicity are useful concepts when attempting to understand differential health risks and health disparities. With cardiovascular diseases accounting for most deaths globally, eliminating racial disparities in cardiac care has become a new challenge in cardiology. Significant racial differences exist in patients with heart failure. African American patients in the US have a significantly higher incidence of heart failure, lower ejection fraction and are younger at presentation compared to White, Hispanic and Chinese American patients. These findings are explained by a higher burden of risk factors such as diabetes mellitus, hypertension, obesity and lower household incomes among African Americans. The authors believe that these findings are applicable to other racial groups across the globe. The prevalence of predisposing risk factors probably has a stronger influence on the incidence of heart failure than the racial factor alone. The interaction between race and diabetes mellitus has important public health implications for the management and prevention of heart failure. The mechanism of HF in patients with DM can be explained by a higher prevalence of risk factors such as IHD, hypertension, and obesity and a direct metabolic effect such as insulin resistance, and increased levels of circulating fatty acids. Both HF and DM are believed to share pathophysiologic processes, including neurohormonal activation, endothelial dysfunction, and increased oxidative stress.1215 Diabetes Mellitus Predisposes Patients to Heart Failure DM is an independent risk factor for the development of HF. The Framingham Study revealed a 2.4-fold increase in symptomatic HF in men and a 5.0-fold Continue reading >>

Glucose-lowering Therapies And Heart Failure In Type 2 Diabetes Mellitus

Glucose-lowering Therapies And Heart Failure In Type 2 Diabetes Mellitus

Glucose-Lowering Therapies and Heart Failure in Type 2 Diabetes Mellitus Mechanistic Links, Clinical Data, and Future Directions Shilpa Vijayakumar, Muthiah Vaduganathan, Javed Butler This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased. Diabetes mellitus independently increases the risk of and mortality from heart failure in a manner that is well established but inadequately understood. Glycemic optimization does not eliminate this risk, and measures of glycemic control are insufficient markers of cardiovascular risk. In response to a regulatory guidance from the US Food and Drug Administration, glucose-lowering agents are now routinely evaluated in large cardiovascular outcome trials. These recent trial experiences of novel and established glucose-lowering therapies have shown variable risks and benefits with respect to heart failure. Cardiovascular outcome trials have increasingly included heart failure events as either a component of the primary end point or a secondary adjudicated end point. We comprehensively review each established and novel currently marketed glucose-lowering therapy, their biological targets, mechanisms of action, and relationships with heart failure. We then highlight gaps in available evidence and directions for future research regarding the ascertainment of heart failure-related data in the evaluation of emerging glucose-lowering therapies. Continue reading >>

Influence Of Diabetes Mellitus On Heart Failure Risk And Outcome

Influence Of Diabetes Mellitus On Heart Failure Risk And Outcome

Abstract Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure. The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy. Treatment of heart failure in diabetic patients The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients. Background Heart failur Continue reading >>

Heart Failure In The Diabetic Population – Pathophysiology, Diagnosis And Management

Heart Failure In The Diabetic Population – Pathophysiology, Diagnosis And Management

Go to: Introduction Heart failure (HF) is the most common cardiovascular complication of diabetes mellitus (DM) [1, 2]. This is not surprising since DM and HF share common pathogenetic factors (Figure 1). Heart dysfunction in the diabetic population may develop regardless of typical risk factors such as hypertension and coronary artery disease [3]. The increased incidence of heart failure in diabetic subjects is supported by results of numerous epidemiological studies that indicate the strong association between DM and HF. These observations are further supported by evidence from experimental studies showing structural and functional dysfunction of diabetic myocardium [4]. Certainly, comorbidities accelerate the likelihood of developing cardiac dysfunction in diabetes, but it is still to be elucidated why diabetic patients are at increased risk of HF. The cause of HF in diabetes is certainly multifactorial in nature, but hyperglycemia and insulin resistance seem to be the core factors. Furthermore, the results of some studies suggest that an increased risk of HF may be associated with specific therapies, such as insulin [5], sulfonylurea (SU), gliptins or glitazones [6]. However, the effects of drugs should be assessed with extreme caution, since diabetic patients often receive multiple therapies simultaneously or over time. In this review, we discuss the evidence regarding the coexistence of heart failure and diabetes, along with its pathophysiology and management. We searched using electronic databases (PUBMED/MEDLINE (1966 – December 2012), EMBASE and SCOPUS (1965 – December 2012)). Additionally, retrospective studies, as well as small studies with the number of patients below 100, and animal studies were also included. The main data search terms were: diabetes m Continue reading >>

Heart Failure As A Risk Factor For Diabetes Mellitus

Heart Failure As A Risk Factor For Diabetes Mellitus

Heart Failure as a Risk Factor for Diabetes Mellitus Background: Diabetes mellitus (DM) is a well-recognized risk factor for heart failure (HF). We hypothesized that HF also increases the risk for DM. Objective: We explored the hypothesis that HF is a risk factor for DM. Methods: The Cardiovascular Health Study was a prospective cohort study of cardiovascular risk in ambulatory older adults. We used a limited-access dataset provided by the National Heart, Lung and Blood Institute. The impact of HF at baseline on DM after 3 or 4 years was examined in a cohort of 3,748 nondiabetic participants aged 65 years. The magnitude and significance of the association were evaluated using logistic regression models. Analyses were performed with and without adjustment for confounders and separately among subjects with normal and impaired fasting glucose at baseline. Results: Among subjects with normal fasting glucose at baseline, HF significantly increased the odds of developing impaired fasting glucose after 3 or 4 years [odds ratio (OR) 2.18, 95% confidence interval (CI) 1.03-4.61, p = 0.043] or overt DM (OR 4.78, 95% CI 1.84-12.4, p < 0.001). After adjusting for demographic and biomedical factors, HF remained significantly associated with a worsening DM status (OR 2.43, 95% CI 1.38-4.29, p = 0.002). Conclusions: In the elderly population, the presence of HF more than doubles the incidence of DM within a few years. This association remains significant when adjusting for age, gender and cardiovascular comorbidities. Diabetes mellitus (DM) is a well-recognized risk factor for many cardiovascular diseases. By accelerating atherosclerosis, DM facilitates the progression of ischemic heart disease, stroke and peripheral vascular disease. The relationship of DM with heart failure (HF) is Continue reading >>

Heart Failure In Patients With Diabetes Mellitus

Heart Failure In Patients With Diabetes Mellitus

Diabetes mellitus is highly prevalent amongst patients with heart failure, especially those with heart failure and preserved ejection fraction (HFpEF), and patients with the two conditions have a higher risk of mortality compared with patients without diabetes or heart failure.13 Diabetic patients have an increased risk of developing heart failure because of the abnormal cardiac handling of glucose and free fatty acids (FFAs), and because of the effect of the metabolic derangements of diabetes on the cardiovascular system. Furthermore, the metabolic risk of diabetes in heart failure is heightened by the effect of most anti-diabetic medications, as the use of certain anti-diabetic agents increase the risk of mortality and hospitalisation for heart failure both in patients with and without heart failure.4 This effect may be related to a direct effect of the glucose-lowering molecules on the cardiovascular system and/or to a negative effect of excessive glucose lowering, since lenient glycaemic control with newer therapeutic agents has shown to reduce significantly mortality, morbidity and risk of developing heart failure in diabeticpatients with proven cardiovascular disease.5 A wealth of epidemiological evidence demonstrates that diabetes mellitus is independently associated with the risk of developing heart failure, with the risk increasing by more than twofold in men and by more than fivefold in women.1-3,6 Heart failure is highly prevalent (25 % in chronic heart failure and up to 40 % in acute heart failure) in patients with diabetes mellitus. Its prevalence is four-times higher than that of the general population, suggesting a pathogenetic role of diabetes in heart failure. This pathogenetic role is also suggested by the fact that patients with diabetes and without Continue reading >>

More in diabetes