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Diabetic cardiomyopathy

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Opinion statement

Diabetes mellitus is a major risk factor for the development of congestive heart failure (CHF). Diabetic cardiomyopathy has been acknowledged as a distinct disease entity that is an additional risk for diabetic patients to develop CHF, especially when they are affected by hypertension or epicardial coronary artery disease. Moreover, diabetic cardiomyopathy has been documented to lead to CHF even in the absence of other risk factors. As the combination of hypertension and diabetes has shown to be particularly detrimental, aggressive blood pressure control with a goal of less than 130/85 mm Hg is of critical importance. The first choice for pharmacologic treatment is angiotensinconverting enzyme inhibitors. Double- or triple-drug therapy is frequently required for good control. The increased risk of epicardial coronary artery disease in patients with diabetes warrants stringent treatment of dyslipidemia. If dilated cardiomyopathy with low ejection fraction is present, therapy with angiotensin-converting enzyme inhibitors, digoxin, diuretics, beta-blockers, and spironolactone (for patients with New York Heart Association class III to IV functional status) is indicated. If cardiac dysfunction consists predominantly of impaired diastolic function, heart rate control with a beta-blocker or a calcium antagonist is of particular importance. Control of blood glucose should be achieved, with hemoglobin A1c levels of less than 7%. Hyperinsulinemia should be avoided when possible; therefore, insulin-sensitizing agents are preferred over insulin-secretion-enhancing agents. Symptoms of CHF and acutely decompensated CHF should be treated no differently than nondiabetic patients. Care for patients with diabetes always includes lifestyle changes consisting of smoking cessation, decreasing obesity, regular exercise, and a heart-healthy diabetic diet.

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References and Recommended Reading

  1. Gu K, Cowie C, Harris M: Diabetes and decline in heart disease mortality in US adults. JAMA 1999, 281:1291–1297.

    Article  PubMed  CAS  Google Scholar 

  2. Pailolle C, Dahan M, Paycha F, et al.: Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type I (insulin-dependent) diabetic patients. Am J Cardiol 1990, 64:1100–1106.

    Google Scholar 

  3. Yudkin JS: How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects. BMJ 1993, 306:1313–1318.

    PubMed  CAS  Google Scholar 

  4. Wei M, Gibbons LW, Kampert JB, et al.: Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med 2000, 132:605–611.

    PubMed  CAS  Google Scholar 

  5. Schneider SH, Amorosa LF, Khachadurian AK, et al.: Studies on the mechanism of improved glucose control during regular exercise in type 2 (noninsulin-dependent) diabetes. Diabetologia 1984, 26:355–360.

    Article  PubMed  CAS  Google Scholar 

  6. Grady KL, Dracup K, Kennedy G, et al.: Team management of patients with heart failure: a statement for healthcare professionals from The Cardiovascular Nursing Council of the American Heart Association. Circulation 2000, 102:2443–2456. Practical advice for providing guidance and assistance for patients with CHF.

    PubMed  CAS  Google Scholar 

  7. Long BJ, Calfas KJ, Wooten W, et al.: A multisite field test of the acceptability of physical activity counseling in primary care: project PACE. Am J Prev Med 1996, 12:73–81. The PACE (Physician-based Assessment and Counseling for Exercise) program assists health-care providers in overcoming barriers to counseling patients about physical activity. The PACE program is potentially an importanat part of a national effort to enhance the adoption and maintenance of physical activity among adults.

    PubMed  CAS  Google Scholar 

  8. Gibbons RJ, Balady GJ, Beasley JW, et al.: ACC/AHA guidelines for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997, 30:260–311.

    Article  PubMed  CAS  Google Scholar 

  9. Goldstein RE, Andrews M, Hall WJ, Moss AJ: Marked reduction in long-term cardiac deaths with aspirin after a coronary event. Multicenter Myocardial Ischemia Research Group. J Am Coll Cardiol 1996, 28:326–330.

    Article  PubMed  CAS  Google Scholar 

  10. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet 2000, 355:253-259.

  11. Young JB, Gheorghiade M, Uretsky BF, et al.: Superiority of “triple” drug therapy in heart failure: insights from the PROVED and RADIANCE trials. Prospective Randomized Study of Ventricular Function and Efficacy of Digoxin. Randomized Assessment of Digoxin and Inhibitors of Angiotensin-Converting Enzyme. J Am Coll Cardiol 1998, 32:686–692. A prospective clinical trial in patients with symptomatic CHF investigating four treatment regimens: 1) diuretics alone, 2) digoxin and diuretics, 3) ACE inhibitors and diuretics, or 4) digoxin, diuretic, and ACE inhibitor. The data analysis suggested that triple-drug therapy is superior to other drug regimens in decreasing worsening of cardiac function.

    Article  PubMed  CAS  Google Scholar 

  12. Cohn JN, Archibald DG, Ziesche S, et al.: Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med 1986, 314:1547–1552.

    Article  PubMed  CAS  Google Scholar 

  13. Cohn JN, Johnson G, Ziesche S, et al.: A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991, 325:303–310.

    Article  PubMed  CAS  Google Scholar 

  14. Sharma D, Buyse M, Pitt B, Rucinska EJ: Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Am J Cardiol 2000, 85:187–192.

    Article  PubMed  CAS  Google Scholar 

  15. Packer M, O’Connor CM, Ghali JK, et al.: Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group. N Engl J Med 1996, 335:1107–1114.

    Article  PubMed  CAS  Google Scholar 

  16. Packer M, Coats AJ, Fowler MB, et al.: Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001, 344:1651–1658. This prospective trial used beta-blockers in the treatment of patients with severe heart failure, and showed benefit in regard to morbidity and mortality.

    Article  PubMed  CAS  Google Scholar 

  17. Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717. A prospective trial showing that the use of spironolactone in medical regimens for patients with severe CHF decreased hospital admissions and improved clinical symptoms.

    Article  PubMed  CAS  Google Scholar 

  18. Malmberg K: Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) study group. BMJ 1997, 314:1512–1515.

    PubMed  CAS  Google Scholar 

  19. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD investigators. N Engl J Med 1992, 327:685-691.

  20. Brown NJ, Agirbasli MA, Williams GH, et al.: Effect of activation and inhibition of the renin-angiotensin system on plasma PAI-1. Hypertension 1998, 32:965–971.

    PubMed  CAS  Google Scholar 

  21. Alkharouf J, Nalinikumari K, Corry D, Tuck M, et al.: Long-term effects of the angiotensin converting enzyme inhibitor captopril on metabolic control in non-insulin-dependent diabetes mellitus. Am J Hypertens 1993, 6:337–343.

    PubMed  CAS  Google Scholar 

  22. Herings RM, de Boer A, Stricker BH, et al.: Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme. Lancet 1995, 345:1195–1198.

    Article  PubMed  CAS  Google Scholar 

  23. Giles TD, Katz R, Sullivan JM, et al.: Short- and longacting angiotensin-converting enzyme inhibitors: a randomized trial of lisinopril versus captopril in the treatment of congestive heart failure. The Multicenter Lisinopril-Captopril Congestive Heart Failure Study Group. J Am Coll Cardiol 1989, 13:1240–1247.

    Article  PubMed  CAS  Google Scholar 

  24. Giugliano D, Acampora R, Marfella R, et al.: Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial. Ann Intern Med 1997, 126:955–959.

    PubMed  CAS  Google Scholar 

  25. The effects of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. N Engl J Med 1997, 336:525-533.

  26. Garratt KN, Brady PA, Hassinger NL, et al.: Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction. J Am Coll Cardiol 1999, 33:119–124.

    Article  PubMed  CAS  Google Scholar 

  27. Randeree HA, Omar MA, Motala AA, Seedat MA: Effect of insulin therapy on blood pressure in NIDDM patients with secondary failure. Diabetes Care 1992, 15:1258–1263.

    Article  PubMed  CAS  Google Scholar 

  28. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. N Engl J Med 1996, 335:217-225.

  29. Hammond T, Tanguay JF, Bourassa MG: Management of coronary artery disease: therapeutic options in patients with diabetes. J Am Coll Cardiol 2000, 36:355–365.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, University of Vermont College of Medicine, Fletcher Allen Health Care, 111 Colchester Avenue, 05401, Burlington, VT, USA

    Susanne Trost MD & Martin LeWinter MD

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  1. Susanne Trost MD
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  2. Martin LeWinter MD
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Trost, S., LeWinter, M. Diabetic cardiomyopathy. Curr Treat Options Cardio Med 3, 481–492 (2001). https://doi.org/10.1007/s11936-001-0022-9

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  • DOI: https://doi.org/10.1007/s11936-001-0022-9

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