Diabetes and Heart FailureThe Role of Thiazolidinediones in Managing These Partners in Crime

摘要

Over 30 years ago, data from the Framingham cohort established a link between diabetes mellitus (DM) and heart failure (HF) (1). Most HF trials have since shown a 25% to 35% prevalence of DM in HF populations. Diabetes mellitus is associated with an increased mortality and hospital readmission rate in patients with HF, and uncontrolled DM and hyperglycemia reduce the effectiveness of standard HF therapies (2,3). The increasing age and the obesity epidemic in our society are increasing the incidence and prevalence of both DM and HF.Diabetes mellitus is a major risk factor for the development of HF through its propagation of atherosclerotic cardiovascular disease, diabetic cardiomyopathy, and ne-phropathy. Diabetes mellitus and hyperglycemia evoke lipid disorders, endothelial dysfunction, platelet hyperreactivity, an elevation of proinflammatory cytokines, circulating free fatty acids and adhesion molecules, and oxidative stress of myocardium. These derangements must adversely affect the pathophysiology and clinical course of HF. However, their impact does not simply begin with established DM. Pre-diabetes-insulin resistance itself is associated with left ventricular (LV) dysfunction, HF, and increased cardiovascular mortality (4-6). Each 1% elevation of glycosylated hemoglobin (HbAlc) can be linked to an 8% increased risk of HF, and hyperglycemia over time increases HF symptoms. Heart failure itself engenders insulin resistance, and in turn, the insulin resistance adversely affects HF and fosters HF as an atherogenlc condition (7-10).