Heart Failure and Nephropathy

Abstract

Heart failure (HF) is a major contributor to poor quality of life, a leading cause of hospitalization, and cause of premature death. Both kidney disease and diabetes are major and independent risk factors for the development of heart failure, such that individuals with diabetic nephropathy are at especially high risk. Such patients not only are likely to have coronary artery disease and hypertension but also are likely to have diabetic cardiomyopathy, a distinct pathologic entity that is more closely associated with the microvascular than the macrovascular complications of diabetes. In addition to a better understanding of the epidemiology of HF, advances in noninvasive imaging have highlighted the importance of early cardiac dysfunction in diabetes and the high prevalence of HF with preserved left ventricular systolic function. Although significant renal dysfunction is usually an exclusion criterion in HF trials, diabetes is often a prespecified subgroup so that subanalyses of large multicenter clinical trials do provide some guidance in therapeutic decision-making. However, further therapies for both HF and nephropathy in diabetes clearly are needed, and a number of new therapeutic strategies that target both disorders have already entered the clinical arena.

Early myocardial impairment in type 1 diabetes patients without known heart disease assessed with tissue Doppler echocardiography: The Thousand & 1 study

“…5 Heart disease in diabetes is often characterized by premature coronary atherosclerosis, although a diabetes-specific myopathy without concomitant coronary artery disease (CAD) has been proposed, 6 diabetic cardiomyopathy, 7,8 which may lead to heart failure. [9][10][11] Heart failure is a common manifestation of CVD in diabetes patients [12][13][14] and can occur without macrovascular disease. [15][16][17] In a recent register-based study, it was shown that the incidence of heart failure in T1DM patients aged between 41 and 45 years was the same as in individuals from the general population aged 55-64 years.…”

Echocardiographic, electrocardiographic and blood pressure changes induced by icodextrin solution in diabetic patients on peritoneal dialysis

“…1 Each of these conditions implies an elevated risk of morbidity and mortality, particularly of cardiovascular origin. [2][3][4][5] ESRD is accompanied by fluid overload, 6 hypertension, 7 inflammation, malnutrition, and accelerated atherosclerosis.…”

Cost-Effectiveness of Aliskiren in Type 2 Diabetes, Hypertension, and Albuminuria

“…This also may have imparted a conservative bias to our findings, because cardiovascular events in this patient population are associated with both reduced quality of life and substantial medical costs. [22][23][24][25] In conclusion, our findings suggest that, on the basis of results of the AVOID trial, the addition of aliskiren to losartan and optimal antihypertensive therapy in patients with type 2 diabetes, hypertension, and albuminuria would be considered cost-effective from a US health care payer perspective.…”