Cardiology Letters 2020, 29(1):9-16

Heart failure and diabetes mellitus. Dangerous association

Gonçalvesová E

Klinika kardiológie LF UK a Národný ústav srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika

Increased risk of cardiovascular disease in type 2 diabetes mellitus (DM II) is generally understood in association with the higher incidence of atherosclerotic vascular occlusive events such as myocardial infarction, stroke and atherosclerotic peripheral artery disease. However, one of the most common and serious cardiovascular disorders in patients with diabetes is heart failure (HF). Patients - men with DM II are at more than three times higher risk of developing HF; in women with diabetes the risk is up to five times higher. After the clinical manifestation of HF in a diabetic patient, prognosis is much worse than without HF. Some surveys show that in diabetic patients over 65 years of age, the one-year mortality after HF manifestation is almost nine times higher than in comparable subjects without HF. Arterial hypertension, coronary disease and metabolic disorders resulting from diabetes itself play a role in the development of HF. Thus, we can in general speak of damage to the heart due to diabetes and associated disorders. The pharmacological treatment of heart failure in patients with DM II is not different in comparison with non-diabetics. Thorough control of blood glucose and other risk factors of cardiovascular disease reduces the risk of developing HF in diabetic patients. In patients with DM II who have already developed HF, the strategy of strict control of DM II no longer reduces the risk of death or other cardiovascular events. In patients with DM II who are at risk of developing HF (patients with hypertension and / or myocardial infarction treatment), treatment with SGLT2 inhibitors reduces the risk of cardiovascular death, incidence and hospitalization for HF. Other antidiabetic drugs have a negative or neutral effect on HF. These unique properties of SGLT2 inhibitors have also been reflected in the 2019 Guidelines of European Society of Cardiology which recognize them as first-line drugs in patients with DM II and atherosclerotic cardiovascular disease, or at very high or high risk of atherosclerotic cardiovascular disease.

Keywords: heart failure; type II diabetes mellitus; SGLT2 inhibitors

Published: January 1, 2020  Show citation