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Heart Failure in the Diabetic Patient

Heart Failure in the Diabetic Patient. Maria Rosa Costanzo, M.D., F.A.C.C., F.A.H.A. Medical Director, Midwest Heart Specialists-Advocate Medical Group Heart Failure and Pulmonary Arterial Hypertension Programs Medical Director, Edward Hospital Center for Advanced Heart Failure

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Heart Failure in the Diabetic Patient

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  1. Heart Failure in the Diabetic Patient Maria Rosa Costanzo, M.D., F.A.C.C., F.A.H.A. Medical Director, Midwest Heart Specialists-Advocate Medical Group Heart Failure and Pulmonary Arterial Hypertension Programs Medical Director, Edward Hospital Center for Advanced Heart Failure Naperville, Illinois, U.S.A.

  2. “We demonstrate that young subjects with uncomplicated type 1 diabetes mellitus have impaired myocardial energeticsirrespective of the duration of diabetes and that the impaired cardiac energetics status is independent of coronary microvascularfunction. We postulate that impairment of cardiac energetics in these subjects primarily results from metabolic dysfunction rather than microvascular impairment.”

  3. Prevalence of DM in General Population with and without HF

  4. Prevalence of DM in Populations with and without LVSD

  5. Prevalence of DM in Patients with HF in Clinical Trials

  6. DM and Mortality in HF: Clinical Trials Populations

  7. DM and Mortality in HF: Non Clinical Trials Populations

  8. Risk Factors For Congestive Heart Failure Hypertension Myocardial Infarction Angina Pectoris Diabetes Mellitus Left Ventricular Hypertrophy Valvular Heart Disease Women Men 0 2 4 6 8 10 Relative Risk of CHF Wilson PW. Am J Cardiol1997;80:3-8

  9. Prediction of Heart Failure in Women with CAD Adjusted HR for HF Diabetes 3.1 Atrial Fib 2.9 CrCL 40-60 1.2 <40 2.3 SBP 120-139 1.6 140-159 2.1 <159 2.1 Smoking Past 1.2 Current 1.9 BMI 25-36 1.2 >36 1.9 LBBB 1.6 LVH 1.5 CABG 1.3 (Bibbins-Domingo K, et al. Circulation 2004;1424-1430)

  10. All: p = 0.0001 Men: p = 0.0001 Women: p = 0.009 Iribarren C et al. Circulation 2001; 103: 2668

  11. Association between Elevated Blood Glucose and Outcome in Acute HFin a Multinational Cohort of 6,212 Subjects Risk of Death Associated with Elevated BG as a Function of the Presence or Absence of DM on Admisssion 30-Day Mortality Rates According to Admission Blood Glucose Mebaaza A et al. JACC 2013; 61:820-9

  12. Association of HgbA1c with Risk of HF in 10 Studies with Maximally adjusted Covariates Association of HgbA1c with Risk of HF in Patients Subgroups Erqou S. et al. Eur J Heart Fail 2013; 15: 185-193

  13. Shekelle PG et al. JACC 2003; 41:1529-38

  14. Shekelle PG et al. JACC 2003; 41:1529-38

  15. Conclusions • HF and DM commonly coexist • Each condition increases the likelihood of developing the other • When HF and DM coexist in the same patient the risk of morbidity and mortality increases markedly • Screening strategies are needed to identify DM patients at high risk of HD and those with asymptomatic LVSD • A strong effort must be made to place patients with coexisting HF and DM on optimal HF therapy • Strategies for managing DM in patients with HF must be tested in prospective controlled clinical trials • Patients with both DM and HF require the care of a multidisciplinary team aware of the unique issues characterizing the two conditions.

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