Diabetes, impaired fasting glucose, and heart failure: Its not all about the sugar

摘要

Introduction: The linkage between diabetes and the development of cardiovascular disease is well established, including the development of a distinct diabetic cardiomyopathy, the co-existence of coronary artery disease (CAD) and the high prevalence (up to 40%) of diabetes in patients presenting with acute heart failure (AHF). Patients with diabetes are at higher risk of developing heart failure (HF) and, once present, it is associated with poor clinical outcomes. However, the adequacy of glycaemic control for patients with both diabetes and HF remains controversial with no clear association of glycated haemoglobin (HbA_(1c)) and clinical events. Abnormalities in glucose regulation in patients without diabetes, such as impaired fasting glucose (IFG), abnormal oral glucose tolerance, or an elevated HBA_(1c), is present in up to 23% of HF patients, Furthermore, IFG is associated with worse outcomes in the setting of acute HF. Thus, there are three major questions that need addressing when dissecting issues relating to glucose regulation in patients with HF: (i) Is diabetes independent and directly driving the complications seen in patients with HF, or are the associated co-morbidities (CAD, hypertension, and renal disease) the driving force?; (ii) Why do patients with concomitant diabetes and HF do worse than patients without diabetes?; (iii) Can any diabetes-related therapy modify the outcomes for patients with HF?