Diabetes mellitus and congestive heart failure

SOLANG, L

doi:10.1053/euhj.1998.1472

Cited by 159 publications

(93 citation statements)

References 56 publications

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“…These findings are well correlated with those of human studies that indicate that asymptomatic diabetic patients generally had diastolic dysfunction and only a portion of subjects later developed systolic dysfunction. 9,32 Serial clinicopathological investigation of DM rats revealed that the decrease of VEGF expression in the myocardium was the initial event, followed by EC apoptosis, decreases in capillary density, and decreases in circulating EPC counts. These changes were followed by diastolic dysfunction, CMC apoptosis, myocardial degeneration, replacement fibrosis, and finally systolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Progressive Attenuation of Myocardial Vascular Endothelial Growth Factor Expression Is a Seminal Event in Diabetic Cardiomyopathy

et al. 2005

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Background-Diabetic cardiomyopathy (DCM) is characterized by microvascular pathology and interstitial fibrosis, which leads to progressive heart failure; however, the pathogenesis of DCM remains uncertain. Methods and Results-Using the streptozotocin-induced diabetic rat model, we evaluated the natural course of DCM over a period of 1 year by serial echocardiography, Western blot analysis for vascular endothelial growth factor (VEGF), endothelial progenitor cell assays, myocardial blood flow measurements, and histopathologic analysis that included terminal dUTP nick end-labeling (TUNEL), capillary and cardiomyocyte density, and fibrosis area. Downregulation of myocardial VEGF expression preceded all other features of DCM and was followed by increased apoptosis of endothelial cells, decreased numbers of circulating endothelial progenitor cells, decreased capillary density, and impaired myocardial perfusion. Apoptosis and necrosis of cardiomyocytes ensued, along with fibrosis and progressive diastolic and then systolic dysfunction. To provide further evidence of the central role of VEGF in the pathophysiology of DCM, we replenished myocardial VEGF expression using naked DNA gene therapy via direct intramyocardial injection of plasmid DNA encoding VEGF (phVEGF 165 ). VEGF-replenished rats showed increased capillary density, decreased endothelial cell and cardiomyocyte apoptosis, and in situ differentiation of bone marrow-derived endothelial progenitor cells into endothelial cells. These anatomic findings were accompanied by significant improvements in cardiac function. Conclusions-These

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Section: Discussionmentioning

confidence: 99%

Progressive Attenuation of Myocardial Vascular Endothelial Growth Factor Expression Is a Seminal Event in Diabetic Cardiomyopathy

et al. 2005

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“…28 The Framingham investigators described a "diabetic cardiomyopathy" that is associated with heart failure particularly in diabetic women, independent of coronary disease. 29 Although the pathophysiological basis for a distinct diabetic cardiomyopathy remains controversial, 30,31 there is evidence that diabetes affects the myocardium, inducing increased left ventricular mass, diastolic dysfunction, alterations in endothelial function, and direct metabolic effects on myocytes. 30,32 Our finding that diabetes is a potent risk factor for heart failure independent of coronary disease status may support the hypothesis that diabetes operates via direct effects on the myocardium.…”

Section: Discussionmentioning

confidence: 99%

“…29 Although the pathophysiological basis for a distinct diabetic cardiomyopathy remains controversial, 30,31 there is evidence that diabetes affects the myocardium, inducing increased left ventricular mass, diastolic dysfunction, alterations in endothelial function, and direct metabolic effects on myocytes. 30,32 Our finding that diabetes is a potent risk factor for heart failure independent of coronary disease status may support the hypothesis that diabetes operates via direct effects on the myocardium. However, all the women in this cohort had underlying coronary disease, so we cannot exclude the possibility that the adverse effects of diabetes operated via the coronary vasculature.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Heart Failure Among Women With Coronary Disease

Bibbins‐Domingo

Lin²,

Vittinghoff³

et al. 2004

Circulation

152

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Background-Although heart failure is common among women with coronary disease, the risk factors for developing heart failure have not been well studied. We determined the risk factors for developing heart failure among postmenopausal women with established coronary disease. Methods and Results-This is a prospective cohort study using data from the Heart and Estrogen/progestin Replacement Study (HERS), a randomized, blinded, placebo-controlled trial of 4.1 years' duration, and subsequent open-label observational follow-up for 2.7 years (HERS II), performed at 20 US clinical centers between 1993 and 2000. Of the 2763 postmenopausal women with established coronary disease in the HERS trial, we studied the 2391 women with no heart failure at baseline by self-report and physical examination. The primary outcome of this analysis was incident heart failure defined by hospital admission or death from heart failure. During the 6.3Ϯ1.4-year follow-up, 237 women (10%) developed heart failure. Nine predictors were identified: diabetes (defined as a self-reported history of diabetes on treatment), atrial fibrillation, myocardial infarction, creatinine clearance Ͻ40 mL/min, systolic blood pressure Ͼ120 mm Hg, current smoking, body mass index Ͼ35 kg/m 2 , left bundle-branch block, and left ventricular hypertrophy. Randomization to estrogen/progestin was not associated with heart failure (hazard ratioϭ1.0; 95% CI, 0.7 to 1.3). Diabetes was the strongest risk factor (adjusted hazard ratioϭ3.1; 95% CI, 2.3 to 4.2). Diabetic women with elevated body mass index or depressed creatinine clearance were at highest risk, with annual incidence rates of 7% and 13%, respectively. Among diabetic women, hyperglycemia was associated with heart failure risk (adjusted hazard ratioϭ3.0; 95% CI, 1.2 to 7.5 for fasting glucose Ͼ300 mg/dL compared with fasting glucose 80 to 150 mg/dL). Conclusions-We identified 9 predictors of heart failure in postmenopausal women with coronary disease. Diabetes was the strongest risk factor, particularly when poorly controlled or with concomitant renal insufficiency or obesity.

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“…As a result, CAD has replaced hypertension and valvular heart disease as the primary cause of CHF (10,11). In addition, because CHF is an age-related condition, incidence and prevalence of CHF (and diabetes) can be expected to increase as the population ages (12,13). The objectives of this study were 1) to estimate prevalence and incidence of CHF in a representative contemporary population of individuals with type 2 diabetes and in an age-and sex-matched population without diabetes and 2) to identify current risk factors for CHF in diabetes.…”

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confidence: 99%

Congestive Heart Failure in Type 2 Diabetes

Nichols

Hillier

Erbey³

et al. 2001

Diabetes Care

540

276

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OBJECTIVE -To estimate the prevalence and incidence of congestive heart failure (CHF) in populations with and without type 2 diabetes and to identify risk factors for diabetes-associated CHF.RESEARCH DESIGN AND METHODS -We searched the inpatient and outpatient electronic medical records of 9,591 individuals diagnosed with type 2 diabetes before 1 January 1997 and those of an age-and sex-matched control group without diabetes for a diagnosis of CHF. Among those without a baseline diagnosis of CHF, we searched forward for 30 months for incident cases of CHF. We constructed multiple logistic regression models to identify risk factors for both prevalent and incident CHF.RESULTS -CHF was prevalent in 11.8% (n ϭ 1,131) of diabetic subjects and 4.5% (n ϭ 435) of control subjects at baseline. We observed incident cases of CHF in 7.7% of diabetic subjects free of CHF at baseline (650 of 8,460) and in 3.4% of control subjects (314 of 9,156). In diabetic subjects, age, diabetes duration, insulin use, ischemic heart disease, and elevated serum creatinine were independent risk factors for both prevalent and incident CHF. Better glycemic control at baseline, and improved glycemic and blood pressure control at follow-up predicted the development of CHF.CONCLUSIONS -Despite controlling for age, duration of diabetes, presence of ischemic heart disease, and presence of hypertension, insulin use was associated with both prevalent and incident CHF. Why insulin use and better glycemic control both at baseline and follow-up independently predicted CHF deserves further study.

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Diabetes mellitus and congestive heart failure

Cited by 159 publications

References 56 publications

Progressive Attenuation of Myocardial Vascular Endothelial Growth Factor Expression Is a Seminal Event in Diabetic Cardiomyopathy

Progressive Attenuation of Myocardial Vascular Endothelial Growth Factor Expression Is a Seminal Event in Diabetic Cardiomyopathy

Predictors of Heart Failure Among Women With Coronary Disease

Congestive Heart Failure in Type 2 Diabetes

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