Evidence of a bi-directional relationship between heart failure and diabetes: a strategy for the detection of glucose abnormalities and diabetes prevention in patients with heart failure.

IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Diabetology Pub Date : 2024-09-28 DOI:10.1186/s12933-024-02436-3
Paul Valensi
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Abstract

Prevalence of heart failure (HF) and diabetes are markedly increasing globally. In a population of HF patients, approximately 40% have diabetes which is associated with a more severe HF, poorer cardiovascular outcomes and higher hospitalization rates for HF than HF patients without diabetes. Similar trends were shown in HF patients with prediabetes. In addition, the association between HF and renal function decline was demonstrated in patients with or without diabetes. However, the exact prevalence of dysglycemia in HF patients requires further investigation aiming to clarify the most accurate test to detect dysglycemia in this population. The relationship between HF and diabetes is complex and probably bidirectional. In one way, patients with diabetes have a more than two-fold risk of developing incident HF with reduced or preserved ejection fraction than those without diabetes. In the other way, patients with HF, when compared with those without HF, show an increased risk for the onset of diabetes due to several mechanisms including insulin resistance (IR), which makes HF emerging as a precursor for diabetes development. This article provides epidemiological evidence of undetected dysglycemia (prediabetes or diabetes) in HF patients and reviews the pathophysiological mechanisms which favor the development of IR and the risks associated with these disorders in HF patients. This review also offers a discussion of various strategies for the prevention of diabetes in HF patients, based first on fasting plasma glucose and HbA1c measurement and if normal on an oral glucose tolerance test as diagnostic tools for prediabetes and unknown diabetes that should be performed more extensively in those patients. It discusses the implementation of diabetes prevention measures and well-structured management programs for HF patients who are generally overweight or obese, as well as current pharmacotherapeutic options for prediabetes, including sodium-glucose cotransporter 2 inhibitors which are among the pillars of HF treatment and which recently showed a benefit in the reduction of incident diabetes in HF patients. Thus, there is an urgent need of routine screening for dysglycemia in all HF patients, which should contribute to reduce the incidence of diabetes and to treat earlier diabetes when already present.

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心力衰竭与糖尿病之间双向关系的证据:检测心力衰竭患者血糖异常和预防糖尿病的策略。
在全球范围内,心力衰竭(HF)和糖尿病的发病率正在明显上升。在心力衰竭患者中,约有 40% 患有糖尿病,与无糖尿病的心力衰竭患者相比,糖尿病患者的心力衰竭程度更严重,心血管预后更差,住院率更高。患有糖尿病前期的高血压患者也有类似的趋势。此外,无论是否患有糖尿病,高血压与肾功能衰退之间的关系都得到了证实。然而,高血压患者中血糖异常的确切发病率还需要进一步调查,以明确在这一人群中检测血糖异常的最准确测试方法。心房颤动与糖尿病之间的关系很复杂,而且可能是双向的。一方面,与非糖尿病患者相比,糖尿病患者发生射血分数降低或保留的心房颤动的风险是后者的两倍多。另一方面,由于胰岛素抵抗(IR)等多种机制,与无高血压的患者相比,高血压患者罹患糖尿病的风险增加,这使得高血压成为糖尿病发病的前兆。本文提供了高血脂患者未被发现的血糖异常(糖尿病前期或糖尿病)的流行病学证据,并回顾了有利于高血脂患者发生 IR 的病理生理机制以及与这些疾病相关的风险。本综述还讨论了预防 HF 患者糖尿病的各种策略,首先基于空腹血浆葡萄糖和 HbA1c 测量,如果正常,则基于口服葡萄糖耐量试验,作为糖尿病前期和未知糖尿病的诊断工具,应在这些患者中更广泛地开展。报告还讨论了如何对体重普遍超重或肥胖的高血压患者实施糖尿病预防措施和结构合理的管理方案,以及目前针对糖尿病前期的药物治疗方案,包括钠-葡萄糖共转运体 2 抑制剂,该药物是高血压治疗的支柱之一,最近的研究显示,该药物可有效减少高血压患者的糖尿病发病率。因此,迫切需要对所有高血压患者进行血糖异常常规筛查,这将有助于降低糖尿病的发病率,并在糖尿病已经出现时尽早治疗。
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来源期刊
Cardiovascular Diabetology
Cardiovascular Diabetology 医学-内分泌学与代谢
CiteScore
12.30
自引率
15.10%
发文量
240
审稿时长
1 months
期刊介绍: Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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