Recent large surveys and registries in patients with heart failure, including the Euro Heart Failure Surveys (EHFS) I and II, have shown that diabetes in such patients was also present in 30-40 % of cases. Slightly more women than men were found to have this condition.
This additional metabolic disorder worsens long-term prognosis and complicates the management of patients with acute and chronic heart failure. Analysis of the EHFS II follow-up data documented for the first time an increased early and late mortality in acute heart failure in diabetic patients: At 3 month after hospitalisation for a cardiac decompensation diabetes was more frequent in patients who died (43.3%) than in survivors (32,1%).
A similar association of diabetes with an adverse outcome was found during the post-discharge period between 3 and 12 months (38.2% in non-survivors versus 30.8% in survivors). A multivariate statistical testing has identified diabetes as an independent risk factor contributing to a relative mortality increase of 26% at 1 year. A higher mortality was also observed in diabetic patients with chronic heart failure in the large scale betablocker trial comparing carvedilol and metoprolol (COMET). However, not all surveys in chronic heart failure recognised diabetes as an independent risk factor, probably because other negative prognostic features, such as a markedly reduced left ventricular ejection factor, low blood pressure and renal dysfunction had a greater impact on long term outcome.
The presence of diabetes also influences the selection of optimal therapeutic measures in heart failure. Among the modern cardiovascular drugs the angiotensin converting enzyme inhibitors (ACEI) and the angiotensin receptor antagonists (ARA) are the most suitable agents in such patients, since they do not increase blood glucose and reduce the occurrence of new diabetes when compared to diuretics and some betablockers. Furthermore, these drugs have also protective effects on the kidneys against diabetic complications.
The choice of invasive cardiac interventions to treat coronary artery disease in patients with and without heart failure may also depend on the presence or absence of diabetes. Coronary artery bypass in patients with multi-vessel coronary disease is considered to be preferable to catheter interventions with regard to long term outcome. The rate of restenosis after percutaneous coronary dilatation is higher in diabetics, although the use of modern drug eluting stents can reduce this risk.
It has been shown that a strict blood sugar control by insulin treatment reduces the rate of cardiovascular diseases in diabetes. Whether the achievement of lower blood sugar values and reduction of glycosilated haemoglobin levels by different means has always a beneficial effect in patients with established cardiovascular diseases remains a debated issue. Recently, some publications have shown that a new antidiatbetic drug, rosiglitazone, which is superior to older drugs in correcting blood sugar, causes fluid retention with signs of heart failure and may even have a negative long term impact by increasing the rate of myocardial infarction and of cardiovascular death. The mode of action of antidiabetic drugs could therefore also be practically relevant.
The most important future task to reduce the negative effects of diabetes in patients with heart failure and coronary artery disease will be the prevention of its development by weight reduction, physical exercise and early treatment of other metabolic risk factors, in particular high cholesterol levels with appropriate drugs.
ESC Press Office | alfa
New malaria analysis method reveals disease severity in minutes
14.08.2017 | University of British Columbia
New type of blood cells work as indicators of autoimmunity
14.08.2017 | Instituto de Medicina Molecular
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
18.08.2017 | Life Sciences
18.08.2017 | Physics and Astronomy
18.08.2017 | Materials Sciences