دانلود رایگان مقاله انگلیسی دیابت و نارسایی قلبی - الزویر 2017

Epidemiologic and clinical data from the last 2 decades have shown that the prevalence of heart failure in diabetes is very high, and the prognosis for patients with heart failure is worse in those with diabetes than in those without diabetes. Experimental data suggest that various mechanisms contribute to the impairment in systolic and diastolic function in patients with diabetes, and there is an increased recognition that these patients develop heart failure independent of the presence of coronary artery disease or its associated risk factors. In addition, current clinical data demonstrated that treatment with the sodium glucose cotransporter 2 inhibitor empagliflozin reduced hospitalization for heart failure in patients with type 2 diabetes mellitus and high cardiovascular risk. This review article summarizes recent data on the prevalence, prognosis, pathophysiology, and therapeutic strategies to treat patients with diabetes and heart failure.

Conclusion

Considering current trial results, patients with diabetes and heart failure may benefit most from glucose-lowering therapies with SGLT2 inhibition. This might relate to the elimination of glucose via the kidney, with net reduction of energetic substrate availability following SGLT2 inhibition, among other possible mechanisms. Reduced energetic substrate availability is also obtained with lifestyle intervention,48,49 which beneficially affects myocardial function in obese patients with and without diabetes. Furthermore, limited evidence suggests beneficial effects with metformin, which reduces energetic substrate availability by decreasing endogenous glucose production, on heart failure in patients with diabetes.56,93 In contrast, no improvement in heart failure, or potential detrimental effects, have been reported for glucose-lowering strategies that directly or indirectly increase the availability of insulin. These considerations should be addressed in future study designs to optimize heart failure therapy in patients with diabetes.