Diabetes mellitus and heart failure: basic mechanisms, clinical features, and therapeutic considerations

The metabolic abnormalities that are associated with diabetes mellitus result in macrovascular and microvascular complications in multiple organ systems; the cardiovascular impact accounts for the greatest morbidity and mortality that are associated with this disease. Heart failure, with reduced or preserved systolic function, is a major complication and arises from the frequent associations with coronary atherosclerosis, hypertension, and a specific heart muscle dysfunction (cardiomyopathy) that occurs independently of coronary artery disease. Hyperglycemia, insulin resistance, and hypertension, together with activation of circulating and tissue renin-angiotensin-aldosterone systems, contribute to structural fibrosis and autonomic neuropathy. It is imperative to identify cardiac abnormalities early in the course of type 1 and type 2 diabetes to allow for early and aggressive intervention to control glucose and blood pressure and to normalize blood lipid profiles.