Diabetes Care: Modern management of heart failure in diabetics

Heart failure and diabetes are on the rise, and the relationship between the two diseases is well known, with traditional heart failure treatments including new drugs also providing benefits for diabetics.
addition, a number of drugs for type 2 diabetes have been shown to bring significant benefits in terms of cardiovascular morbidity and mortality, such as improved heart failure symptoms, hospitalization and death.
recently, Diabetes Care published a new review called Contemorary Management of Heart Failure in Patients With Diabetes, which outlines current methods for treating patients with heart failure or risk of heart failure and their specific role in diabetic patients.
also discussed the benefits of certain sugar-lowering drugs in treating heart failure patients with or without diabetes.
diabetes increase the risk of heart failure? The exact mechanism for increasing the incidence of heart failure in diabetics is complex.
obesity makes patients prone to insulin resistance and high blood sugar, as well as heart failure, which is also reflected in diabetics.
Diabetes-related cardiac dysfunction has a number of mechanisms, including impaired microvascular endostropheric function, abnormal heart metabolism (especially the heart's abnormal treatment of glucose and free fatty acids), increased cardiomyocardial fibrosis, increased oxidative stress, local activation of neurosterone systems, including nephrine-vascular tension and the intersecting nervous system, and other less typical path pathogens such as endopitin.
despite numerous preclinical studies showing a particular type of diabetic cardiomyopathy, these findings are controversial.
However, these preclinical studies have enabled researchers to identify potential pathways, and historically, most studies on diabetes have focused on atherosclerosis rather than the direct effects of diabetes on heart function, so this area has been relatively neglected compared to studies of diabetic microvascular and large vascular complications.
With the maturation of preclinical and clinical techniques, including genomics, metabolomics, proteomics and updated methods to assess mitochondrial function, understanding of the pathophysiology of diabetes-related heart failure that reduces and retains blood test scores (EF) is expected to expand significantly over the next decade.
specific heart failure drugs and their role in diabetic patients HFrEF are treated mainly around the nephrine-angiotensin and the sensory nervous system, ACEI, ARB, β-subject blockers, saline corticosteroid antagonists (MRAs), sinus node inhibitors such as braivabradine and, most recently, sacubitril/prostatin, which can significantly reduce CV events in HFrEF patients.
The incidence of diabetes among study participants ranged from 20 percent to nearly 50 percent, and the proportion of diabetics has increased over the past 20 years in major clinical trials of heart failure, although none of these drugs have been specifically targeted at diabetics.
Large heart failure trials using existing evidence-based therapies and the percentage of diabetes subjects in each trial have a risk/benefit of sugar-lowering drugs and heart failure Due to increased attention to cardiovascular events in certain anti-sugar therapies, cardiovascular events have become the end point of FDA mandates involving trials of new anti-sugar therapies.
interestingly, in recent studies, SGLT2 inhibitors have been beneficial, though not common, in reducing hospitalization and cardiac mortality from heart failure.
study of these drugs was carried out in diabetic patients with combined cardiovascular disease.
mechanisms for cardiovascular benefits of these drugs have not been fully explained, and the effects of weight loss, lowering blood pressure and lowering blood sugar do not fully explain their benefits.
There is also a view that has not been clearly demonstrated that changes in the heart's utilization of ketones may be a bio-chemical mechanism that explains improvements in heart function after SGLT2 inhibition, although this hypothesis is highly speculative and controversial, as mentioned earlier.
for heart failure, the role of these drugs in sodium-promoting agents may be critical.
these drugs also have good effects on atherosclerosis and vascular resistance, visceral obesity, proteinuria and plasma uric acid markers.
in short, the relationship between heart failure and diabetes, two major epidemic diseases, is very important.
of diabetic cardiomyopathy is now clear.
previously, the treatment of heart failure had focused on the renin-angiosin-aldosterone and the sensory nervous system, with ACEI/ARBs/MRAs and blockers being the main focus of treatment.
these drugs reduce heart failure mortality and hospitalization rates in HFrEF patients, including those with diabetes.
However, recent newer treatments, the SGLT2 inhibitors that initially primarily lower blood sugar, have been shown to provide symptom improvement and prognosis benefits to subjects with and without diabetes, and should therefore be seen as an additional treatment for all HFrEF patients, not just for diabetics.
reference: Diabetes Care 2020 Dec; 43 (12): 2895-2903.MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Original" are owned by Mets Medical and are not authorized to reproduce, and any media, website or individual may not reproduce them with the words "Source: Mets Medicine".
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