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Impact of Diabetes on Epidemiology, Treatment, and Outcomes of Patients With Heart Failure
Open accessAbstract
The prevalence of patients with concomitant heart failure (HF) and diabetes mellitus (DM) continues to increase with the general aging of the population. In patients with chronic HF, prevalence of DM is 24% compared with 40% in those hospitalized with worsening HF. Patients with concomitant HF and DM have diverse pathophysiologic, metabolic, and neurohormonal abnormalities that potentially contribute to worse outcomes than those without comorbid DM. In addition, although stable HF outpatients with DM show responses that are similar to those of patients without DM undergoing evidence-based therapies, it is unclear whether hospitalized HF patients with DM will respond similarly to novel investigational therapies. These data support the need to re-evaluate the epidemiology, pathophysiology, and therapy of HF patients with concomitant DM. This paper discusses the role of DM in HF patients and underscores the potential need for the development of targeted therapies.
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“Since the report of the Framingham Heart study, type 2 diabetes (T2DM) has been known to increase the incidence of HF up to more than double with respect to non-affected individuals, with the growing awareness that this complication may develop independently of coronary artery disease (CAD) and associated risk factors [8,9,10,11].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [10]
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“Importantly, eplerenone seems to have no effect on new-onset T2DM in patients with HF, suggesting a neutral metabolic profile.160”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [160]
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Self-citationNew Insights in Cardiac β-Adrenergic Signaling During Heart Failure and Aging
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Self-citationDauriz, M., Targher, G., Laroche, C., Temporelli, P. L., Ferrari, R., Anker, S., Coats, A., Filippatos, G., Crespo-Leiro, M., Mebazaa, A., et al. (2017) · Diabetes Care · doi:10.2337/dc16-2016 · Cited by 139
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BackgroundPCSK9 deficiency rewires heart metabolism and drives heart failure with preserved ejection fraction
Dalt, L. D., Castiglioni, L., Baragetti, A., Audano, M., Svecla, M., Bonacina, F., Pedretti, S., Uboldi, P., Benzoni, P., Giannetti, F., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab431 · Cited by 123
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Self-citationImpact of SGLT2 Inhibitors on Heart Failure: From Pathophysiology to Clinical Effects
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Self-citationHyperglycemia Induces Myocardial Dysfunction via Epigenetic Regulation of JunD
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MethodLate Graft Failure in Heart Transplant Recipients: Incidence, Risk Factors and Clinical Outcomes
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“D iabetes mellitus is a surging contributor to the epidemic of heart failure (HF).(1) In patients with symptomatic HF, the presence of diabetes mellitus independently increases the risk of cardiovascular outcomes such as HF hospitalization rates and mortality.”
BackgroundComorbidities in Heart Failure: Are There Gender Differences?
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“In rodent and porcine nondiabetic HFrEF models, SGLT2i improved left ventricular ejection fraction (LVEF) [18–20] but not diastolic function [20], and showed conflicting results in left ventricular structure [18–21].”
BackgroundInfluentialDiabetes and Heart Failure: Multi-Omics Approaches
Tayanloo-Beik, A., Roudsari, P. P., Rezaei–Tavirani, M., Biglar, M., Tabatabaei‐Malazy, O., Arjmand, B., & Larijani, B. A. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.705424 · Cited by 46
“It has been estimated that 1% higher glycosylation of Hb is associated with about 8% higher risk for HF (Cas et al., 2015).”
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Fenofibrate and Heart Failure Outcomes in Patients With Type 2 Diabetes: Analysis From ACCORD
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Skeletal Muscle Weakness is Related to Insulin Resistance in Patients with Chronic Heart Failure
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miR‑155 modulates high glucose‑induced cardiac fibrosis via the Nrf2/HO‑1 signaling pathway
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Impact of Diabetes Mellitus on Outcomes in Patients Supported With Left Ventricular Assist Devices
Asleh, R., Briasoulis, Α., Schettle, S. D., Tchantchaleishvili, V., Pereira, N. L., Edwards, B. S., Clavell, A. L., Maltais, S., Joyce, D. L., Joyce, L. D., et al. (2017) · Circulation Heart Failure · doi:10.1161/circheartfailure.117.004213 · Cited by 41
“Specifically, DM was associated with significantly higher all-cause mortality, as well as higher rates of infection and thromboembolic events after adjustment for other variables, (2) PreLVAD HbA1c level was not a significant predictor of outcomes in patients with DM during LVAD support, and (3) Glycemic control as in…”
BackgroundPotential mechanisms of beneficial effect of sacubitril/valsartan on glycemic control
Seferović, J. P., Solomon, S. D., & Seely, E. W. (2020) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018820970444 · Cited by 41
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“The prevalence of patients with both HF and diabetes keeps increasing as the population is ageing [5] and diabetes is among the most common comorbidities in HF patients, potentially increasing the risk of hospitalization and death [5].”
BackgroundAl-Hayali, M. A., Sözer, V., Durmuş, S., Erdenen, F., Altunoğlu, E., Gelışgen, R., Atukeren, P., Atak, P. G., & Uzun, H. (2019) · Biomolecules · doi:10.3390/biom9050193 · Cited by 39
“A quarter of those with chronic HF have diabetes and over 40% of these patients are hospitalized with worsening HF [1,3].”
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Wilkinson, M. J., Zadourian, A., & Taub, P. R. (2019) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2019.10.024 · Cited by 40
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“In addition, Dei Cas et al. (2015) reported that the frequency of patients with heart failure and DM will increase with the general aging of the population.”
BackgroundNeves, J. S., Correa, S., Baptista, R. B., Vieira, M. B., Waikar, S. S., & Causland, F. R. M. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa017 · Cited by 40
New Management Strategies in Heart Failure
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“outcome and pathophysiology of HF is an area of great investigative interest.(44) GLP-1 is a naturally occurring incretin pep-”
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“Glycated endproducts from hyperglycemia also lead to microvascular dysfunction and decreased nitric oxide bioavailability in the vascular endothelium, which are processes implicated in HFpEF pathogenesis (12).”
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“Moreover, patients with diabetes develop heart failure with a worse prognosis, more than twice that of patients without diabetes [6, 7].”
BackgroundSonaglioni, A., Cerini, F., Fagiani, V., Nicolosi, G. L., Rumi, M. G., Lombardo, M., & Muti, P. C. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14082690 · Cited by 35
Review on sodium-glucose cotransporter 2 inhibitor (SGLT2i) in diabetes mellitus and heart failure
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“Hyperglycemia induces diabetes‐specific changes in microvascular architecture such as impaired nitric oxide production with consequent endothelial dysfunction, decreased vessel density, and increased permeability.[7] The rennin–angiotensin–aldosterone system (RAAS) is activated early in DM.”
BackgroundInfluentialMetformin Attenuates Postinfarction Myocardial Fibrosis and Inflammation in Mice
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“Patients with diabetes have over twice the risk of developing heart failure (HF) than patients without diabetes mellitus [2].”
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“Chronic obesity and diabetes are potent mediators of diabetic cardiomyopathy [1,2].”
BackgroundAntihyperglycemic Therapies to Treat Patients With Heart Failure and Diabetes Mellitus
Sharma, A., Cooper, L. B., Fiuzat, M., Mentz, R. J., Ferreira, J. P., Butler, J., FITCHETT, D. H., Moses, A. C., O’Connor, C. J., & Zannad, F. M. (2018) · JACC Heart Failure · doi:10.1016/j.jchf.2018.05.020 · Cited by 29
Self-citationSudden cardiac death in heart failure with preserved ejection fraction: a target for therapy?
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Metadata
- Authors
- Dei Cas, A., Khan, S. S., Butler, J., Mentz, R. J., Bonow, R. O., Avogaro, A., Tschoepe, D., Doehner, W., Greene, S. J., Senni, M., Gheorghiade, M., & Fonarow, G. C.
- Affiliations
- Northwestern University (US)
- Stony Brook University (US)
- Duke Medical Center (US)
- University of Padua (IT)
- University Hospitals of the Ruhr-University of Bochum (DE)
- Center for Stroke Research Berlin (DE)
- Ospedale Papa Giovanni XXIII (IT)
- University of California, Los Angeles (US)
- Corresponding author
- Fonarow, Gregg C.
- ORCID
- Venue
- JACC Heart Failure
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 3
- Issue
- 2
- Pages
- 136-145
- ISSN
- 2213-1779 (ISSN-L)
- OpenAlex
- W2072535229
- Cited by
- 401
- References
- 59
- Citations by year
- 2026: 8 · 2025: 28 · 2024: 33 · 2023: 17 · 2022: 55 · 2021: 69 · 2020: 55 · 2019: 31 · 2018: 40 · 2017: 20 · 2016: 26 · 2015: 19
- FWCI
- 6.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Funders
- Amgen
- Boston Scientific Corporation
- National Institutes of Health
- Agency for Healthcare Research and Quality
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- heart failure, diabetes mellitus, comorbidities, prevalence, pathophysiology, metabolic abnormalities, treatment outcomes, targeted therapy
- MeSH terms
- Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Autonomic Nervous System Diseases, Diabetes Mellitus, Diuretics, Fatty Acids, Nonesterified, Heart, Heart Failure, Humans, Insulin Resistance, Mitochondria, Heart, Myocardium, Renin-Angiotensin System, Renal Insufficiency, Vascular Remodeling
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