Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association

Abstract

Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.

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“…These findings suggest that patients in this group have hyperlipidemia, which is a risk factor for cardiovascular disease. In addition to hyperglycemia, an increase in the incidence of cardiovascular disease (CVD) among patients with T2DM has led to a greater recognition of hypertension and hyperlipidemia as important targets of therapy [30]. Clinical studies in T2DM patients have revealed that lowering cholesterol and maintaining tight blood pressure management lowers the risk of significant cardiovascular events [31,32].…”

“…A case control study that included (100) patients and (35) healthy controls were all included in this study. Patients (43 males, 57 females) were separated into three groups: (35) type 2 diabetes mellitus (14 males, 21 females), (30) hypertension (12 males, 18 females), and (35) type 2 diabetes mellitus with hypertension (17 males, 18 females). Participants in the control group (20 males, 15 females) were matched by the age, weight, and had no disease.…”

“…The goal of the study is to find if there is a link between T2DM, hypertension, and the other some biochemical parameters. This study included that 135 participants in this study, with 100 of them being patients with T2DM (35), hypertension (30), patients with T2DM and hypertension (35), and the remaining (35) being healthy controls who met the inclusion criteria. T2DM, hypertension, and type 2 diabetic hypertensive patients, as well as healthy controls had the blood collected under the aseptic conditions.…”

Association of biomarkers and risk scores with subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus

“…Prevalence rates of abnormal clinical biomarker levels based on ADA guidelines were reported (cut-off levels defined as NTpBNP > 125 pg/mL or hs-TnT > 12.5 pg/mL [latter based on manufacturer’s recommendation of the 99 th percentile for the assay]) [ 10 ].…”

“…The STOP-HF study used a strategy of BNP-guided management to institute preventative therapies and screening with echocardiography to further assess subclinical LVD [ 5 ]. Based on this and other published papers on the utility of measuring clinical biomarkers to assess risk of future HF [ 6 – 9 ], the recent American Diabetes Association (ADA) guidelines suggest measuring NTpBNP and hs-TnT in all patients without a history of clinical HF to delineate the need for cardiac imaging [ 10 ]. This study aimed to examine the utility of risk scores (ARIC-HF and WATCH-DM) and clinical biomarkers (NTpBNP and hs-TnT) in detecting subclinical LVD or structural heart disease (SHD) in community-based populations with T2DM thus identifying those with stage B HF and at risk of progression to symptomatic HF.…”