Diabetes Mellitus and Heart Failure

Abstract

The coexistence of diabetes mellitus (DM) and heart failure (HF) is frequent and is associated with a higher risk of hospitalization for HF and all-cause and cardiovascular mortality. It has been estimated that millions of people are affected by HF and DM, and the prevalence of both conditions has increased over time. Concomitant HF and diabetes confer a worse prognosis than each alone; therefore, managing DM care is critical for preventing HF. This article reviews the prevalence of HF and diabetes and the correlated prognosis as well as provides a basic understanding of diabetic cardiomyopathy, including its pathophysiology, focusing on the relationship between DM and HF with a preserved ejection fraction and summarizes the potential aldosterone and the mineralocorticoid receptor antagonists approaches for managing heart failure and DM. Sodium-glucose cotransporter 2 inhibitors (SGLT2Is) are an emerging class of glucose-lowering drugs, and the role of SGLT2Is in DM patients with HF was reviewed to establish updated and comprehensive concepts for improving optimal medical care in clinical practice.

Keywords: diabetes mellitus; heart failure; preserved ejection fraction; reduced ejection fraction; sodium–glucose cotransporter 2 inhibitors.

Figure 1

Mechanisms of Heart Failure and Renoprotective Benefits of SGLT2 inhibitor. SGLT2i, Sodium-glucose Cotransporter 2 Inhibitor; RASS, renin-angiotensin-aldosterone system; BP, blood pressure; IL-6, Interleukin 6; TNF, Tumor Necrosis Factor; MMP, Matrix metalloproteinases; FN1, fibronectin 1; NHE, sodium-hydrogen exchanger.