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Novel insight into the dangerous connection between diabetes and heart failure

Neue Erkenntnisse zur gefährlichen Verbindung von Diabetes und Herzversagen

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Abstract

Heart failure (HF) affects approximately 1–2 % of the adult population. Diabetes mellitus (DM) is one of the most frequent comorbidities in HF, portending a worse prognosis. DM is associated with an increased risk of artery disease, and consequently of post-ischemic HF, but it may also alter directly the myocardial structure and function. Insights into the pathophysiological mechanisms of diabetic cardiomyopathy have been provided by both experimental and clinical investigations. In recent years, it has emerged that the fibrotic process is a result of the convergence of multiple neurohormonal alterations in diabetic cardiomyopathy at the basis of disease progression and phenotype determination: HF with reduced or preserved ejection fraction. Therapies for HF and DM should demonstrate an improved prognosis and have a neutral effect on glucose homeostasis and the risk of HF development.

Zusammenfassung

Herzversagen (heart failure, HF) betrifft ungefähr 1–2 % der erwachsenen Bevölkerung. Diabetes mellitus (DM) ist eine der häufigsten Komorbiditäten bei HF und deutet auf eine verschlechterte Prognose hin. DM ist mit einem erhöhten Risiko von Arterienerkrankungen verbunden, und infolgedessen mit einer Entwicklung zu post-ischämischem HF, er kann aber auch direkt die myokardiale Struktur und Funktion verändern. Einblicke in die pathophysiologischen Mechanismen von diabetischer Kardiomyopathie wurden sowohl von experimentellen als auch von klinischen Untersuchungen geliefert. In den letzten Jahren hat sich der fibrotische Prozess als Ergebnis des Zusammenlaufens multipler neurohormonaler Veränderungen bei diabetischer Kardiomyopathie aufgrund des Krankheitsverlaufs und der Phänotypbestimmung herausgestellt: HF mit verringerter oder erhaltener Auswurfleistung. Therapien für HF und DM sollten eine verbesserte Prognose zeigen und eine neutrale Wirkung sowohl auf die Glukosehomöostase und als auch auf das Risiko der HF-Entwicklung haben.

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Authors and Affiliations

  1. Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Parma and AOU of Parma, Parma, Italy

    C. Lombardi

  2. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiology, University of Brescia, Brescia, Italy

    V. Spigoni & E. Gorga

  3. Via Gramsci 14, 43126, Parma, Italy

    A. Dei Cas

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C. Lombardi, V. Spigoni, E. Gorga, and A. Dei Cas state that there are no conflicts of interest.

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Lombardi, C., Spigoni, V., Gorga, E. et al. Novel insight into the dangerous connection between diabetes and heart failure. Herz 41, 201–207 (2016). https://doi.org/10.1007/s00059-016-4415-7

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