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Cardio Diabetes Medicine 2017 227

Congestive Heart Failure in Diabetic...!

How it is Different?

Dr. Dhanushkodi, MD.,
TUTICORIN

ABSTRACT increased the risk for the other. Patients with ad-
(4)
The prevalence of congestive heart failure in diabe- vanced CHF show marked insulin resistance a condi-
tes mellitus is growing exponentially compared to tion associated with an increased risk of developing
those patients without diabetes mellitus, patients of Type 2 DM compared to normal individual or patients
congestive heart failure with diabetes mellitus shows with coronary artery disease (CAD)
specific metabolic, neurohumeral and structural heart
abnormalities EPIDEMIOLOGY
The prevalence of patients with both CHF and DM
Subgroup analysis of recent trials suggested that pa-
tients of congestive heart failure with diabetes mel- in the general population is estimated at 0-5% in
litus may respond difficulty to standard therapy and men and 0.4% in women. CHF afflicts 1-2% of the
data are emerging on the possible increase in the risk general population rising to >5-10% in subjects aged
visit of hospitalizations., when treated with specific >65years whereas the prevalence of DM worldwide
(5)
class of antidiabetic agents pointing to the need of is estimated at 5-6% and it is predicted to increase
(6)
developing specific medications to be tested in the to >8% of the adult population by 2030
near future studies. The prevalence of both diseases is increasing world-
wide with the aging of the general population 1.5 to
INTRODUCTION 2% of individuals over the age of 65 have both CHF
and DM and the prevalence is expected to grow ex-
CHF is one of the most common reasons for hospital (7)
admission in those aged 65 and over with conse- ponentially in the next decates.
(8)
quent high costs for the health care system. In addition these prevalence figures tend to under-
“Despite improvements in the treatment of patients estimate the true impact as they do not adequately
with chronic HF with reduced EF, the survival of the account for undiagnosed, CHF in patients with pre-
patients hospitalized form CHF remains poor, with served ejection fraction (EF) or impaired fasting glu-
one year mortality of 30% and 5-year mortality up to cose (4)
50%. Approximately 40% of patients hospitalized with There are now emerging data that congestive heart
CHD and reduced ejection fraction (EF) have DM.”(1) failure with preserved ejection fracture (HFpEF) also
DM is one of the non cardiac co-morbidities associ- presents with multiple phenotypes including meta-
ated with notably higher risks for both all causes and bolic abnormalities and coronary microvascular in-
HT related preventable hospitalizations and re-hos- flammation likewise HFpEF similar to heart failure
(9)
pitalization (10) with reduced ejection fraction is strongly associat-
In patients with DM the prevalence of CHF is be- ed with diabetes mellitus Compared to non-diabetic
tween 9-22% which is 4 times higher than the gen- HFpEF patients, diabetic HFpEF patients tend to be
eral population and DM is a risk factor for CHF younger, more obese, more likely hypertensive, have
(11)
development specially in women (5-fold) compared more renal function impairment and more vascular
(12)
to, men (2-4fold) . The relationship between DM and disease. HFpEF patients with diabetes have more
CHF is bidirectional with each disease independently left ventricular hypertrophy, a trend towards higher

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