Heart failure in diabetes mellitus
Heart failure in diabetes mellitus
Richard W Nesto, MD
May 2008
UptoDate
INTRODUCTION AND DEFINITION Û Diabetes 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 heart failure in diabetic patients will be reviewed here. The prevalence of and risk factors for coronary heart disease among patients with diabetes mellitus are discussed separately. (See "Prevalence of and risk factors for coronary heart disease in diabetes mellitus").
EPIDEMIOLOGY Û There is a well established association between diabetes and HF that is linked at least in part to coronary heart disease and hypertension. Associations have also been reported between absolute blood glucose levels, glycemic control, and HF.
Diabetes and HF Û 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 heart failure independent of coexisting hypertension or coronary disease. When patients with prior coronary or rheumatic heart disease were excluded, the relative risk of HF remained elevated at 3.8 in diabetic men and 5.5 in diabetic women.
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