How Diabetes Affects Your Heart – Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease:
High blood pressure increases the force of blood through your arteries and can damage artery walls. Having both high blood pressure and diabetes can greatly increase your risk for heart disease. Too much LDL (“bad”) cholesterol in your bloodstream can form plaque on damaged artery walls. High triglycerides (a type of fat in your blood) and low HDL (“good”) cholesterol or high LDL cholesterol is thought to contribute to hardening of the arteries.
None of these conditions has symptoms. Your doctor can check your blood pressure and do a simple blood test to see if your LDL, HDL, and triglyceride levels are high. These factors can also raise your risk for heart disease:
Smoking Being overweight or having obesity Not getting enough physical activity Eating a diet high in saturated fat, trans fat, cholesterol, and sodium (salt) Drinking too much alcohol
People with diabetes are also more likely to have heart failure, Heart failure is a serious condition, but it doesn’t mean the heart has stopped beating; it means your heart can’t pump blood well. This can lead to swelling in your legs and fluid building up in your lungs, making it hard to breathe. Get regular checkups to keep track of your heart health.
Can diabetes cause heart failure?
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Abstract Diabetes and heart failure are closely related: patients with diabetes have an increased risk of developing heart failure and those with heart failure are at higher risk of developing diabetes. Furthermore, antidiabetic medications increase the risk of mortality and hospitalisation for heart failure in patients with and without pre-existing heart failure. When the two diseases are considered individually, heart failure has a much poorer prognosis than diabetes mellitus; therefore heart failure has to be a priority for treatment in patients presenting with the two conditions, and the diabetic patient with heart failure should be managed by the heart failure team. No specific randomised clinical trials have been conducted to test the effect of cardiovascular drugs in diabetic patients with heart failure, but a wealth of evidence suggests that all interventions effective at improving prognosis in patients with heart failure are equally beneficial in patients with and without diabetes. The negative effect of glucose-lowering agents in patients with heart failure or at increased risk of heart failure has become evident after the withdrawal of rosiglitazone, a thiazolidinedione, from the EU market due to evidence of increased risk of cardiovascular events and hospitalisations for heart failure. An important issue that remains unresolved is the optimal target level of glycated haemoglobin, as recent studies have demonstrated significant reductions in total mortality, morbidity and risk of heart failure despite achieving HbA1c levels similar to those observed in the UKPDS study conducted some decades ago. Meta-analyses showed that intensive glucose lowering is not associated with any significant reduction in cardiovascular risk but conversely results in a significant increase in heart failure risk. Different medications have different risk: benefit ratios in diabetic patients with heart failure; therefore, the heart failure team must judge the required intensity of glycaemic control, the type and dose of glucose lowering agents and any change in glucose-lowering therapy, according to the clinical conditions present. Disclosure: The authors have no conflicts of interest to declare. Received: 28 September 2016 Accepted: 27 October 2016 Correspondence Details: Giuseppe MC Rosano, Clinical Academic Group Cardiovascular, St George’s Hospital NHS Trust Medical School, Cranmer Terrace, London, UK. E: [email protected] Copyright Statement: The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content. Diabetes mellitus is highly prevalent amongst patients with heart failure, especially those with heart failure and preserved ejection fraction (HFpEF), and patients with the two conditions have a higher risk of mortality compared with patients without diabetes or heart failure.1–3 Diabetic patients have an increased risk of developing heart failure because of the abnormal cardiac handling of glucose and free fatty acids (FFAs), and because of the effect of the metabolic derangements of diabetes on the cardiovascular system. Furthermore, the metabolic risk of diabetes in heart failure is heightened by the effect of most anti-diabetic medications, as the use of certain anti-diabetic agents increase the risk of mortality and hospitalisation for heart failure both in patients with and without heart failure.4 This effect may be related to a direct effect of the glucose-lowering molecules on the cardiovascular system and/or to a negative effect of excessive glucose lowering, since lenient glycaemic control with newer therapeutic agents has shown to reduce significantly mortality, morbidity and risk of developing heart failure in diabeticpatients with proven cardiovascular disease.5 A wealth of epidemiological evidence demonstrates that diabetes mellitus is independently associated with the risk of developing heart failure, with the risk increasing by more than twofold in men and by more than fivefold in women.1-3,6 Heart failure is highly prevalent (25 % in chronic heart failure and up to 40 % in acute heart failure) in patients with diabetes mellitus. Its prevalence is four-times higher than that of the general population, suggesting a pathogenetic role of diabetes in heart failure. This pathogenetic role is also suggested by the fact that patients with diabetes and without heart failure have an increased risk of developing heart failure compared with a matched population (29 versus 18 %, respectively). In patients with diabetes mellitus, advanced age, duration of the disease, insulin use, presence of coronary artery disease and elevated serum creatinine are all independent risk factors for the development of heart failure.7 When the two diseases are considered individually, heart failure has a much poorer prognosis than diabetes mellitus, therefore heart failure has to be a priority for treatment in patients presenting with the two conditions, and the diabetic patient with heart failure should be managed by the heart failure team. This review will focus on the relationship between heart failure and type 2 diabetes mellitus. Mechanisms of Cardiac Dysfunction in Diabetes Mellitus The altered systemic and cardiac glucose metabolism of patients with the range of disease that go from impaired glucose control to diabetes mellitus contribute to the structural and functional abnormalities of the heart that culminate in cardiac dysfunction. In diabetic patients, heart failure develops not only because of the underlying coronary artery disease, but also because of the multiple pathophysiological and metabolic abnormalities induced by altered glucose metabolism.8 The impaired cardiac glucose metabolism and the switch of glucose to FFA oxidation that occurs in the diabetic heart has a significant negative effect on cardiac contractility and functioning thereby inducing left ventricular systolic and diastolic dysfunction even in the absence of coronary artery disease (CAD) or structured heart disease.9,10 The alteration of cardiac function in diabetics occurs through several different mechanisms, such as decreased glucose transport and carbohydrate oxidation, increase in FFA utilisation, decrease in sarcolemmal calcium transport, and alterations in myofibrillar regulatory contractile proteins. Cardiac glucose metabolism is compromised at several points in patients with diabetes mellitus: glucose uptake, glycolysis and intramitochondrial pyruvate oxidation. The reduction in the glucose uptake is due to the slow rate of glucose transport across the sarcolemmal membrane into the myocardium, secondary to a reduction in the myocardial concentration of glucose transporter type 1 (GLUT 1) and glucose transporter type 4 (GLUT 4). Patients with diabetes mellitus have higher plasma levels and myocardial uptake of FFA. High levels of circulating FFAs and their increased oxidation are primarily responsible for the inhibition of both glycolysis and glucose oxidation in the heart. Although the shift of cardiac energy substrate utilisation from glucose to FFA oxidation, occurring in the diabetic heart, is essential to ensure continuous adenosine triphosphate (ATP) generation to maintain heart function, this chronically maladaptation leads to decreased energetic reserves and cardiac efficiency. Indeed, diabetic hearts are characterised by a diminished production of high-energy phosphate, since the betaoxidation of FFA is less efficient than the glycolysis in generating energy (in relation to oxygen consumption) and may increase the risk of cardiac dysfunction during increased metabolic demands or ischaemia.9,10 Hyperglycaemia and insulin resistance also contribute to the development of heart failure through several different mechanisms acting independently and synergistically; such as impaired microvascular endothelial function, abnormal cardiac metabolism (shift myocardial utilisation of glucose toward less efficient fatty acid oxidation), increased myocardial fibrosis, increased oxidative stress and local activation of the renin-angiotensin system and sympathetic nervous system.9,10 Diabetes in Patients with Heart Failure Both population studies and clinical trials have demonstrated that diabetes mellitus significantly increases the risk of recurrent hospitalisations for heart failure and the duration of hospital stay in patients with heart failure, and it is associated with a significantly higher mortality compared with those without diabetes.11 In the Candesartan in Heart failure – Assessment of Reduction in Mortality and Morbidity (CHARM) programme the presence of diabetes mellitus was associated with a twofold increase of either death or the composite outcome of cardiovascular death or hospitalisation for heart failure in insulin users, and a 50 % increase risk in non-insulintreated diabetics.3 Diabetic patients with both reduced and preserved left ventricular ejection fraction show increased mortality and morbidity rates compared with patients without diabetes. This increased risk is also observed in those diabetic patients of either ischaemic or non-ischaemic origin. Of interest, the prognostic importance of diabetes mellitus becomes weaker in hospitalised patients for acute heart failure; suggesting that in these patients the prognosis depends more on the severity of cardiac decompensation rather than on metabolic abnormalities. The Treatment of Heart Failure in Diabetics No randomised clinical trials have been conducted to test the effect of cardiovascular interventions (drugs and/or devices) in diabetic patients with heart failure. However, abundant evidence suggests that all interventions effective at improving prognosis in patients with heart failure are equally beneficial in patients with and without diabetes.12 Beta-blockers and angiotensin-converting enzyme inhibitors are beneficial in patients with diabetes mellitus and their use is associated with reduced mortality and hospitalisations. Angiotensin II receptor blockers have shown similar efficacy in heart failure patients with and without diabetes. Although non-selective beta-blockers may have a negative effect on glycaemic control and increase the risk of future diabetes, and these effects may be less frequent with the more selective agents like bisoprolol, carvedilol and nebivolol, there is no reason to suggest a preferential use of a beta-blocker over another on the basis of the possible negative effect on glucose control. Despite a clear benefit of beta-blockers in heart failure patients with diabetes, these patients are still less likely to be discharged from hospital on a beta-blocker than non-diabetic patients with heart failure.12 Mineralocorticoid receptor antagonists are equally effective in patients with heart failure with and without diabetes mellitus. However, because of the frequent coexistence of diabetic nephropathy, a close surveillance of electrolyte and renal function is recommended in order to exclude hyperkalaemia. The two most recent drugs introduced in heart failure treatment, LCZ696 and ivabradine, are similarly effective in heart failure patients with and without diabetes, and should be implemented as suggested by the guidelines of the European Society of Cardiology/Heart Failure Association.12 Anti-diabetic Treatment in Patients with Diabetes and Heart Failure Glucose-lowering agents are known to increase the risk of cardiovascular events especially when a tight glycaemic control is pursued. Although initially linked to ischaemic heart disease, the negative effect of glucose-lowering agents in patients with heart failure or at increased risk of heart failure has become evident after rosiglitazone, a thiazolidinedione, was withdrawn from the EU market because of the evidence of increased risk of cardiovascular events.13 Despite the focus being mainly put on the risk of coronary events, it was evident even from the rosiglitazone saga that the most significant risk with the use of this drug(s) was related to heart failure. Glucose-lowering agents may favour the development of heart failure through several pathophysiological mechanisms related to the increased insulin levels, water retention and low glucose availability for the heart and muscles. The potential detrimental effect of the glucose lowering drugs cannot be dissected by the negative effect of excessive glucose lowering in diabetics. After the United Kingdom Prospective Diabetes Study (UKPDS) the majority of studies in diabetic patients aimed at glycated haemoglobin 1c (HbA1c) <7.5 % or even <7 %, and invariably reported an increased risk of cardiovascular events most often related to heart failure.1,14–18 Therefore, an important issue that is still unsolved is the target level of glycated haemoglobin that should be regarded as optimal – the recent Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG) showed a significant reduction in total mortality, morbidity and risk of heart failure despite the achieved HbA1c which was 7.8 %.5 A meta-analysis of 13 studies including 34,533 patients showed that intensive glucose lowering is not associated with any significant reduction in cardiovascular risk but conversely results in a 47 % increase in risk of heart failure (P<0.001).19 A study conducted in a large cohort of heart failure patients with diabetes mellitus showed a U-shaped relationship between HbA1c and mortality, with the lowest risk in patients with moderate glycaemic control (HbA1c 7.1–8.0 %).14 These results are in agreement with the findings of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, which demonstrated an increase of 21 % in the risk of death from all causes and of 35 % in the occurrence of cardiovascular death with tight control of glucose in patients with diabetes mellitus.20 The importance of hypoglycaemia has also been highlighted by the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) that found a 38 % increased risk of a poorer outcome among patients with hypoglycaemia complicating heart failure post-myocardial infarction (MI).21 The glucose-lowering treatment should be carefully evaluated and gradually implemented in diabetic patients with heart failure. Preference in the treatment of diabetic patients with heart failure should be given to metformin and empagliflozin that have shown to be safe and effective.5,22,23 Metformin is excreted though the kidney, therefore caution should be exerted in patients with impaired renal function and its use is contraindicated only in patients with severe renal or hepatic impairment. Sulphonylureas may frequently cause hypoglycaemia, although this risk is minimised by the slow release formulations. An increased risk of worsening heart failure has been reported with sulphanylureas in cohort studies including diabetic patients but has never been reported by randomised clinical trials.4 These drugs should be used with caution in diabetic patients with heart failure.12 Mitiglinides may induce water retention and should be used with caution in patients with heart failure. Alpha-glucosidase inhibitors like acarbose lack any effect on insulin, water and sodium retention, and are safe to use in patients with increased cardiovascular risk and in those with heart failure. Thiazolidinediones are associated with increased sodium and fluid retention, and increase sympathetic nervous system activity. Randomised clinical trials and meta-analyses have shown that thiazolidinediones increase the risk of heart failure worsening and hospitalisations from heart failure, and they are contraindicated in patients with heart failure.13 Dipeptidyl peptidase-4 inhibitors (DPP4is; gliptins) are trendy drugs for the control of glycaemia in patients with diabetes despite their small effect on HbA1c. Large randomised studies with DPP4i have cast doubts about their safety in heart failure showing an increased risk of heart failure hospitalisations, and despite recent data, suggest that they may be safe to use; given their limited clinical benefit and given that there is a lack of data on their effect in patients with heart failure their use is not recommended except under strict cardiology supervision.24,25,12,26 There are no data on the long term safety of glucagon-like peptide-1 (GLP-1) receptor agonists in patients with heart failure. Recently, liraglutide was tested against placebo in the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial and showed a significant reduction in the composite primary outcome of the first occurrence of cardiovascular death, nonfatal MI or non-fatal stroke, but no effect on heart failure endpoints. Given the absence of detailed data in patients with heart failure, the use of GLP-1 receptor agonists should be implemented only under strict cardiology supervision. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) enhance glucose control by increasing the urinary excretion of glucose. Recently, the SGLT2i empagliflozin showed a significant and relevant effect on cardiovascular protection.5 The EMPA-REG OUTCOME study conducted in 7,020 patients with type 2 diabetes (glycated haemoglobin level, 7.0–10.0 %) at high risk for cardiovascular events followed for a median of 3.1 years has shown that empagliflozin use led to a significant reduction in the rates of death from cardiovascular causes (38 % relative risk reduction), hospitalisation for heart failure (35 % relative risk reduction) and death from any cause (32 % relative reduction). Empagliflozin reduced by 39 % the hospitalisations for or death from heart failure (2.8 versus 4.5 %; HR 0.61 ; P<0.001) and was associated with a reduction in all-cause hospitalisation (36.8 versus 39.6 %; HR 0.89 ; P=0.003). The mechanisms responsible for the effects of empagliflozin on cardiovascular endpoints and heart failure are largely unknown. Potential mechanisms to be proven include effect on sodium retention and plasma volume, osmotic diuresis, reduction of insulin levels and insulin response to food intake, modulation of the renin-angiotensin aldosterone system, reduction weight and blood pressure without increases in sympathetic nervous activity. Insulin is often required for the glucose control of diabetic patients with type 1 diabetes, and of some patients with type 2 diabetes and pancreatic islet beta cell exhaustion. Since insulin induces significant sodium retention precipitating worsening of heart failure, the change in dose, schedule of administration and type of insulin used must be constantly supervised by a cardiologist in patients with chronic heart failure. Therefore, the heart failure team according to the clinical conditions should make the judgement on the intensity of glycaemic control, the type and dose of glucose-lowering agents, and any change in the glucose-lowering therapy should be closely monitored. References
- Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321 :405–12. Crossref | PubMed
- Metra M, Zacà V, Parati G, et al. Cardiovascular and noncardiovascular comorbidities in patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 2011; 12 :76–84. Crossref | PubMed
- MacDonald MR, Petrie MC, Varyani F, et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J 2008; 29 :1377–85. Crossref | PubMed
- Fadini GP, Avogaro A, Degli Esposti L, et al. Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: a retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database. Eur Heart J 2015; 36 :2454–62. Crossref | PubMed
- Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373 :2117–28. Crossref | PubMed
- Ryden L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes,pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the EuropeanAssociation for the Study of Diabetes (EASD). Eur Heart J 2013; 34 :3035–87. Crossref | PubMed
- Wang Y, Negishi T, Negishi K, Marwick TH. Prediction of heart failure in patients with type 2 diabetes mellitus- a systematic review and meta-analysis. Diabetes Res Clin Pract 2015; 108 : 55–66. Crossref | PubMed
- Rosano GM, Vitale C, Fragasso G. Metabolic therapy for patients with diabetes mellitus and coronary artery disease. Am J Cardiol 2006; 98 (5A):14J–18J. Epub ahead of press. Crossref | PubMed
- Nagoshi T, Yoshimura M, Rosano GM, et al. Optimization of cardiac metabolism in heart failure. Curr Pharm Des 2011; 17 (35):3846–53. PMCID:PMC3271354 Crossref | PubMed
- Rosano GM, Fini M, Caminiti G, Barbaro G. Cardiac metabolism in myocardial ischemia. Curr Pharm Des 2008; 14 :2551–62. Crossref | PubMed
- Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med 1991; 325 :293–302. Crossref | PubMed
- Ponikowski P, Voors A, Anker S, et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail 2016; 37 :2129–200. Crossref | PubMed
- Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet 2009; 373 :2125–35. Crossref | PubMed
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- Goode KM, John J, Rigby AS, et al. Elevated glycated haemoglobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus. Heart 2009; 95 : 917–23. Crossref | PubMed
- Aguilar D, Bozkurt B, Ramasubbu K, Deswal A. Relationship of haemoglobin A1C and mortality in heart failure patients with diabetes. J Am Coll Cardiol 2009; 54 :422–8. PMCID:PMC2753214 Crossref | PubMed
- Jeffcoate SL. Diabetes control and complications: the role of glycated haemoglobin, 25 years on. Diabet Med 2004; 21 :657–65. Crossref | PubMed
- Lind M, Odén A, Fahlén M, Eliasson B. A systematic review of HbA1c variables used in the study of diabetic complications. Diabetes Metab Synd: Clin Res Rev 2008; 2 :282–93. Crossref
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Does diabetes put a strain on your heart?
What is the link between diabetes, heart disease, and stroke? – High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. Over time, this damage can lead to heart disease.1 People with diabetes tend to develop heart disease at a younger age than people without diabetes.
Can diabetes damage heart be reversed?
Professor Stephen Wheatcroft discusses whether it’s possible to reverse diabetes, and the steps you can take to slow down its progression. Lifestyle changes play an important part in diabetes control. ” Weight loss (if you’re overweight) coupled with physical exercise are vitally important,” says Dr Stephen Wheatcroft, who leads BHF-funded diabetes studies at the University of Leeds.
“It may not reverse the diabetes, but it will certainly make it much easier to control.” The problems that diabetes causes to the cardiovascular system take years to develop As people with diabetes get older, glucose control becomes increasingly difficult. But that’s no reason to give up eating a healthy diet or doing physical activity – these things can slow down the progression of your diabetes.
“What you can focus on is reversing the harmful effects of diabetes on health, and also trying to delay or prevent progression of the diabetes itself – so you avoid needing to take more medication or needing to move on to insulin,” says Dr Wheatcroft.
“It is possible to reverse the detrimental effects of diabetes on risk of heart disease, in particular. However, that’s probably a long-term aim, because the problems that diabetes causes to the cardiovascular system take years to develop.” Taking this long-term outlook involves permanent lifestyle changes.
Dr Wheatcroft suggests setting yourself “achievable goals”.
Read more about Professor Wheatcroft’s research into diabetes, Get our expert’s view on healthy eating to reduce diabetes risk, Learn more about how to stay healthy in later life, Discover how to eat healthily and enjoy it too,
Can diabetes cause fluid around the heart?
It can lead to inability of the heart to circulate blood through the body effectively, a state known as heart failure, with accumulation of fluid in the lungs (pulmonary edema) or legs (peripheral edema).
|Universal blue circle symbol for diabetes.|
Do diabetics get chest pain?
If you have prediabetes or type 1 or type 2 diabetes, you should be aware of the symptoms of heart disease, including: Chest pain, also known as angina, including feelings of chest tightness or pressure. Shortness of breath.
Should diabetics see a cardiologist?
You should consider seeing a cardiologist if you have diabetes and: Symptoms of heart disease, like chest pain or trouble breathing with activity. High blood pressure or high cholesterol.
Can insulin damage your heart?
Study in mice reveals heart-damaging pathway triggered by insulin, identifies possible drug targets to prevent or treat heart failure – Diabetes is hard on the heart. Cardiovascular disease is the leading cause of death in people with diabetes, and risk for heart failure—where the heart can’t pump enough blood—is two to three times higher in men and up to five times higher in women with diabetes compared to people without diabetes.
In the case of heart failure, diabetes presents another problem: Some of the therapies that treat diabetes may actually make heart failure worse. But new research from the University of Iowa and the University of California at Davis finds that two different drugs—a beta blocker and an antidepressant—might both have potential for preventing or treating heart failure by blocking an insulin signaling pathway in the heart muscle.
“We often have a conundrum when we are treating a person with diabetes who also has heart failure. If we treat the diabetes, then we get better blood sugar numbers, but, depending on the drugs we choose, we could increase the risk of hospitalization for heart failure.
It puts us between a rock and a hard place,” says E. Dale Abel, UI professor and DEO of internal medicine at the University of Iowa Carver College of Medicine. “To improve our ability to care for these patients, it is really important for us to understand what is happening in the failing heart in the context of diabetes.” Previous research points to high levels of insulin, a hallmark of Type 2 diabetes, as a key factor in heart failure associated with diabetes.
The new study, led by Abel and Kevin Xiang at UC Davis, shows that too much insulin in the blood (hyperinsulinemia) contributes to heart failure by triggering a molecular chain reaction that damages heart muscle cells. Using mice with diabetes, the study traced the links in this chain reaction—a newly discovered insulin signaling pathway in heart muscle cells.
Blocking the pathway with the beta blocker carvedilol or the antidepressant paroxetine reverses heart muscle damage and restores heart function in the mice. The findings, published Nov.4 in the journal Circulation, suggest that these drugs might have potential for preventing or treating heart failure associated with Type 2 diabetes.
“The notion that activating insulin signaling can be damaging in the failing heart has been reinforced by this study,” says Abel, who also is director of the Fraternal Order of Eagles Diabetes Research Center at the UI. “I think the main clinical implication is that physicians who are treating these complex patients who have these two dangerous co-morbidities, diabetes and heart failure, need to think about the effect of high levels of insulin on the heart and aim to improve metabolism (blood sugar levels) without getting the insulin levels too high such that that harms the heart.” The signaling pathway that Abel and Xiang discovered involves direct interaction and crosstalk between insulin receptors and another family of receptors called beta-adrenergic receptors.
There are two classes of beta-adrenergic receptors: beta1, which is more abundant and is responsible for regulating the strength of the heartbeat, and beta2, which is believed to be a minor, less important receptor. Targeting beta receptors with beta-blocker drugs is a mainstay treatment for heart failure.
The new study shows that when the insulin receptor is activated by high levels of insulin, it sends a message to the beta2 receptor, which disrupts signaling through the beta1-adrenergic pathway and reduces the heart’s ability to pump, leading to heart failure.
- The new understanding of this signaling pathway identifies the beta2 receptor and a protein called G-protein receptor kinase 2 (GRK2) as potential targets for preventing heart failure associated with diabetes.
- Inhibiting beta2 with the beta-blocker drug carvedilol and GRK2 with a drug called paroxetine reverses some of the heart damage and improves heart function in diabetic mice, even without altering metabolic problems such as high blood sugar and high insulin.
Paroxetine, which is better known as Paxil, is a selective serotonin reuptake inhibitor (SSRI) that is currently used to treat depression. “The dose (of paroxetine) we used in the mice to block GRK2 and produce the beneficial heart effects was much higher than the corresponding human dose used to treat depression,” Abel notes.
Can metformin cause heart problems?
Abstract – Heart failure is a common and serious cardiovascular complication of type 2 diabetes. Many antihyperglycemic drugs can increase the risk of heart failure. However, it is commonly believed that metformin – the first-line treatment for type 2 diabetes – reduces the risk of and improves the clinical course of heart failure.
It is estimated that 20-25% of patients taking metformin have heart failure. Metformin has been shown to have favorable effects on the course of heart failure in experimental models. Furthermore, when compared with other antihyperglycemic medications in nonrandomized epidemiological studies, metformin users had a lower risk of new-onset heart failure and a lower risk of death if they already had heart failure.
However, these reports are difficult to interpret, given the potential for prescribing bias and the likelihood that comparator agents caused cardiovascular harm. Meta-analyses of randomized controlled clinical trials have not demonstrated benefits of metformin on the risk of or the clinical course of heart failure.
Which diabetes medicine is good for heart?
Heart Disease Drug Therapy Recommendations – Currently, both empagliflozin and liraglutide are only approved to treat or prevent heart disease in people with diabetes. If you have diabetes, talk to your doctor about these medications to see if they’re right for you.
Does type 2 diabetes cause heart failure?
By American Heart Association News Please note: This article was published more than two years ago, so some information may be outdated. If you have questions about your health, always contact a health care professional. (Maskot, Getty Images) Having Type 2 diabetes or heart failure independently increases the risk for getting the other, and both often occur together, further worsening a patient’s health, quality of life and care costs, a new report says. Many of the risk factors and mechanisms behind Type 2 diabetes and heart failure are similar, yet there’s a lack of guidance on how to care for people with both conditions, according to a scientific statement from the American Heart Association and the Heart Failure Society of America published Thursday in the journal Circulation,
- Recent studies have found new treatments for diabetes may also improve heart failure outcomes, showing the interplay between the two conditions, the report says.
- The statement summarizes what’s known about the inner workings of diabetes and heart failure and the best ways to treat the conditions when they occur simultaneously.
But it also encourages clinicians to coordinate the care and treatment of patients who have both conditions in “a thoughtful and cohesive way,” said Dr. Shannon Dunlay, who co-chaired the report’s writing committee. It’s not uncommon for a patient to see a cardiologist for heart failure and then visit a primary care doctor or endocrinologist for help managing diabetes, she said.
But physicians need to be aware of how medications used for one condition affect the outcome of another. “There’s so much new data coming out all the time. We want to bring attention to the fact that diabetes and heart failure have substantial overlap, and it’s important to stay up to date on new information,” said Dunlay, a heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota.
Ideally, all the patient’s care teams would be aligned. “It’s easy to focus on the main problem you are treating, such as heart failure. But it’s important to think about other medical conditions patients have when prescribing new therapies,” she said.
- People who have Type 2 diabetes, characterized by elevated blood sugar levels, are two to four times more likely to develop heart failure than someone without diabetes.
- But heart failure, a condition in which the heart fails to efficiently pump oxygenated blood through the body, also is a risk factor for diabetes.
Both disorders are characterized by insulin resistance and high levels of inflammation, said Dr. Rozalina McCoy, another member of the statement’s writing committee. “People who have both these conditions have a much higher risk of worse health outcomes – more hospitalizations, more emergency department visits, earlier death, and worse health overall than people who have just one of these conditions,” said McCoy, an endocrinologist and internal medicine physician at Mayo Clinic.
Since people who have either condition are at increased risk for developing the other, they should take proactive steps to improve their health, she said. It’s important to get regular exercise, maintain a healthy weight and eat a well-balanced diet. People with diabetes also need to keep their blood sugar levels under control.
The statement describes in detail a new class of medications called SGLT-2 inhibitors that lower blood sugar in adults with diabetes. But research shows these drugs also are effective in reducing the risk of developing heart failure and helping manage the condition in those who already have it, preventing heart failure-related hospitalizations and deaths.
What is late stage diabetes?
– While “end-stage diabetes” isn’t a commonly used term, diabetes can lead to what’s known as end-stage diabetic complications, or advanced complications. In people with diabetes, advanced complications, like end-stage renal disease, occur after many years of living with diabetes.
What should blood pressure be for a diabetic?
What is the recommended blood pressure range for people with diabetes? – It’s important to keep your blood pressure within a healthy range. This reduces your chances of your body developing further health complications. Blood pressure should be below 140/80mmHg for people with diabetes or below 130/80mmHg if you have kidney or eye disease or any condition that affects blood vessels and blood supply to the brain.
But it is important to speak to your healthcare team about your individual target. Whilst you may not have any symptoms of high blood pressure, it can be harmful to your health if left untreated. This is due to the increased pressure placed on your heart, eyes, kidneys and other organs. As we’ve said previously, heart attack or stroke are some of the conditions your body becomes more vulnerable to with high blood pressure.
Other conditions you become more at risk of include:
Kidney disease Cardiovascular disease Cardiovascular dementiaHeart failure
By reducing your blood pressure to healthier levels, you reduce your risk of getting these health conditions.
What causes type 2 diabetes with heart disease?
Types of Heart Disease Linked to Type 2 Diabetes From clogged arteries to heart failure, type 2 diabetes can affect your ticker in a lot of ways. To help protect yourself, learn about the kinds of heart disease that are linked to diabetes and the warning signs to watch for.
This is the most common type of heart disease in people with diabetes. When you have it, the arteries that carry blood to the muscle of your heart have a buildup of a fatty, waxy substance called plaque. With time, plaque gets hard and makes your arteries stiff. As more of it collects, there’s less room for blood to flow, so your heart doesn’t get the oxygen it needs.
Clumps of plaque can also burst apart, making you more likely to get blood clots in those vessels. Add it all up, and it can lead to conditions like: Angina, You may feel pain, pressure, or squeezing in your chest. You might even feel it in your arms, back, or jaw as well.
Sometimes it feels a lot like indigestion. Physical activity and strong emotions can set it off or make it worse. Arrhythmia, This is when your heart rate or rhythm is off. You might feel like your heart skips a beat, flutters, or beats too fast. At its worse, it can cause sudden cardiac arrest, where your heart stops beating.
Heart attack, It’s caused by a clot that cuts off blood flow in the arteries of the heart. You’re likely to have pain or discomfort in the center or left side of your chest. But that’s not always the case. With diabetes, you have higher odds of silent heart attacks, where you don’t even feel it happen.
- Despite the name, it doesn’t mean your heart has stopped working.
- It’s just that it’s too weak to pump enough blood to your body.
- Over time, diabetes, coronary heart disease, and high blood pressure all make you more likely to have it.
- They wear down your heart muscle because they keep it working too hard for too long.
When your body doesn’t get enough blood, your cells don’t get the oxygen they need. That can lead to symptoms like:
Feeling tired and weakHard time exercisingHeartbeat that’s too fast or off-rhythmProblems staying focusedSwelling in your legs, ankles, and feetTrouble breathing
If you don’t manage your diabetes closely, you could get a condition called cardiomyopathy. Your heart muscle gets thick and stiff. It just can’t work the same, which can lead to rhythm problems and heart failure. Early on, you might not have any symptoms. But as the condition gets worse, it can lead to:
Shortness of breath, even when you’re restingChest painCoughing, especially when you’re lying downFeeling dizzy or light-headedFeeling weak and tiredSwelling in your legs, ankles, and feet
Diabetes is also tied to: High blood pressure. This happens when blood pushes against the walls of your blood vessels with a stronger force than normal. It makes your heart work harder than usual and damages your blood vessels. Most people with type 2 diabetes also have high blood pressure.
Together, they put a lot of extra strain on your heart, boosting your chance of having serious issues like heart disease and stroke. Peripheral artery disease (PAD). With this condition, you have plaque buildup in the arteries of your legs. It typically causes pain in your calves. You’ll feel it when you walk or climb stairs, and it usually goes away with rest.
Your legs may also feel heavy, numb, or weak. PAD is also a warning sign. That’s because if you have plaque in your legs, you might have it in your heart, too. In fact, PAD raises your odds of having a stroke or heart attack. Stroke. Diabetes also means you’re more likely to have a stroke, where blood flow to part of your brain gets cut off.
Drooping face, causing a lopsided smileA hard time talking, such as slurred speechWeakness in one arm, making it hard to lift and keep both arms in the air
It’s a life-threatening problem, and you need to get medical help right away. The sooner you get treatment, the more likely you are to prevent long-term problems. : Types of Heart Disease Linked to Type 2 Diabetes
What are the main reasons of diabetes and heart diseases?
Heart disease is common in people with diabetes. Data from the National Heart Association from 2012 shows 65% of people with diabetes will die from some sort of heart disease or stroke. In general, the risk of heart disease death and stroke are more than twice as high in people with diabetes.
While all people with diabetes have an increased chance of developing heart disease, the condition is more common in those with type 2 diabetes, In fact, heart disease is the number one cause of death among people with type 2 diabetes, The Framingham Study was one of the first pieces of evidence to show that people with diabetes are more vulnerable to heart disease than those people who did not have diabetes.
The Framingham Study looked at generations of people, including those with diabetes, to try to determine the health risk factors for developing heart disease. It showed that multiple health factors – including diabetes – could increase the possibility of developing heart disease.
Aside from diabetes, other health problems associated with heart disease include high blood pressure, smoking, high cholesterol levels, and a family history of early heart disease. The more health risks factors a person has for heart disease, the higher the chances that they will develop heart disease and even die from it.
Just like anyone else, people with diabetes have an increased risk of dying from heart disease if they have more health risk factors. However, the probability of dying from heart disease is 2 to 4 times higher in a person with diabetes. So, while a person with one health risk factor, such as high blood pressure, may have a certain chance of dying from heart disease, a person with diabetes has double or even quadruple the risk of dying.
- For example, one medical study found that people with diabetes who had no other health risk factors for heart disease were 5 times more likely to die of heart disease than those without.
- Another medical study showed that people with diabetes, no matter the number of other heart disease risk factors, were as likely to have a heart attack as someone without diabetes who has already had a heart attack,
Heart disease experts recommend that all people with diabetes have their heart disease risk factors treated as aggressively as people who have already had heart attacks,