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
Hot cars can hit deadly temperatures in as little as one hour
24.05.2018 | Arizona State University
3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg
The more electronics steer, accelerate and brake cars, the more important it is to protect them against cyber-attacks. That is why 15 partners from industry and academia will work together over the next three years on new approaches to IT security in self-driving cars. The joint project goes by the name Security For Connected, Autonomous Cars (SecForCARs) and has funding of €7.2 million from the German Federal Ministry of Education and Research. Infineon is leading the project.
Vehicles already offer diverse communication interfaces and more and more automated functions, such as distance and lane-keeping assist systems. At the same...
A research team led by physicists at the Technical University of Munich (TUM) has developed molecular nanoswitches that can be toggled between two structurally different states using an applied voltage. They can serve as the basis for a pioneering class of devices that could replace silicon-based components with organic molecules.
The development of new electronic technologies drives the incessant reduction of functional component sizes. In the context of an international collaborative...
At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.
At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...
There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?
At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
25.05.2018 | Event News
02.05.2018 | Event News
13.04.2018 | Event News
25.05.2018 | Event News
25.05.2018 | Machine Engineering
25.05.2018 | Life Sciences