Type 2 Diabetes And Heart Failure

Do You Have Undiagnosed Heart Disease

Heart disease is the often overlooked byproduct of diabetes.

The health care community speaks primarily to the issues of vision loss Nerve/Kidney loss and does not seem to focus on heart disease.

How can you tell if you may have undiagnosed heart failure issues?

For me, the first clue was cankles . EDEMA is the name for the failure of the heart to pump enough blood to clear the body of excess water.

Other common clues are problems breathing when you lay down at night to sleep and have trouble breathing when walking or exercising.

You need to have a medical specialist listen to your heart with a stethoscope. The sounds, to a trained ear, are immediately identifiable.

One thing for sure: you better take seriously any adverse changes to your body. The faster you start a regimen of positive change, the better the outcomes.

Heres How To Lower Your Risk Of A Cardiovascular Event

If you have read this blog post, you will know of the connection between type 2 diabetes and heart disease. Doctors may not know everything about type 2 diabetes including how to cure it but they do know how to treat the symptoms effectively. And that happens to be important in the context of cardiovascular disease. To find out why, read on.

Type 2 Diabetes Management And Cardiovascular Risk Reduction Two Sidesof The Same Coin

Weve been seeing a clear overlap between the following aspects of health:

• preventing the onset of type 2 diabetes
• managing the symptoms of type 2 diabetes
• controlling and keeping BMI steady
• promoting cardiovascular health

But lifestyle changes including a healthy diet, regular exercise and abstinence from smoke and large amounts of alcohol are unfortunately not always enough.

On top of a health-promoting lifestyle, your personal condition may require medication. Surely, no one enjoys depending on a very complicated medical regimen. Its important that you discuss the matter carefully with your doctor to decide which medication can best treat your type 2 diabetes and reduce the risk of cardiovascular events.

Living well means accepting medical help when necessary

If you are like most people living with type 2 diabetes, you can achieve a relationship with your condition that makes life both enjoyable and rewarding.

It may require developing a new, more pragmatic approach to your health one characterised by taking regular action to help your metabolism do what it cannot do unaided.

Does your condition currently require medication? Or can your blood sugar be sufficiently well regulated through diet and exercise? Whatever the specifics of your condition, it is a good idea to

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Diabetes And Heart Attack

Here well explain what can happen in your body to cause these heart complications.

Lets start with the major blood vessels in your body, these are your:

• arteries they carry blood away from your heart
• veins they carry blood back to your heart.

If these arteries and veins get damaged, it can be harder for blood to flow around the body and get to the areas its needed.

High cholesterol

If your cholesterol is too high, then the extra fat in your blood sticks to the walls of your blood vessels. Over time, this fat hardens and is known as plaque. Hard plaque can block up the blood vessels, which makes the space narrower and leaves less room for blood to flow.

This is called arteriosclerosis or atherosclerosis and is the most common cause of a heart attack.

In the narrower space, blood flow slows down and causes some of the blood cells to group together and clot. If a blood clot breaks away, it will travel through your arteries and veins until it reaches a section too narrow to pass through, making it partially or completely blocked.

This can starve the heart of oxygen and nutrients and this is what causes a heart attack.

High blood pressure

Not only does the blood struggle to flow through the blood vessels, but over time atherosclerosis makes the walls of your blood vessels more rigid and less elastic. This can lead to high blood pressure or make high blood pressure worse.

Treatments For Heart Failure

Treatments for heart failure can vary depending on the root cause or causes.

• Lifestyle changes see preventing heart failure below which list the lifestyle changes that can also help with treating the condition
• Medications which include diuretics, blood pressure medication and blood thinning medication
• Pacemakers or other medical devices such as ICDs or CRT-Ds
• Surgery which may include heart valve surgery, coronary angioplasty, coronary artery bypass graft or heart transplantation

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Availability Of Data And Materials

Not applicable.

Not applicable.

AC: Advisory Board, Consultancy, Lectures: Berlin Chemie, Eli Lilly, Novo Nordisk, Mitsubishi, Roche Diagnostics, Theras.

DC: Advisory Board, Lectures, Consultancy: Novo Nordisk, Eli Lilly, Sanofi, Servier, MSD, Merck, Alfa Wasserman, Bayer, Astra Zeneca, Boehringer-Ingelheim.

CC: The authors declare that they have no competing interests.

FC: research grants from Swedish Research Council, Swedish Heart & Lung Foundation, and King Gustav V and Queen Victoria Foundation, as well as advisory board, consultancy fees from Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim Merck Sharp & Dohme, Lilly, Novo Nordisk, and Pfizer.

ACD: The authors declare that they have no competing interests.

BI: Advisory Board, Consultancy, Lectures: Novo Nordisk, Sanofi, Eli Lilly, Bayer, AstraZeneca, Boehringer Ingelheim, Pfizer, MSD, Roche.

NML: Advisory Board and Lectures for NovoNordisk, Sanofi, Boehringer Ingelheim, Astra Zeneca, Medtronic, Roche, Eli Lilly, Berlin Chemie.

FP: lectures for Berlin Chemie.

OS: AstraZeneca, Bayer, Boehringer Ingelheim, Grünethal, Lilly, MSD, Mundipharma, Novo Nordisk, Roche, Sanofi, Wörwag.

PMS: Lectures for Servier, Astra Zeneca, Respicardia, Menarini Consultancy agreement for Boehringer Ingelhein, Vifor Pharma, Novartis, Roche diagnostic.

ES: Personal fees from Oxford Diabetes Trials Unit, Bayer, Berlin Chemie, Boehringer Ingelheim, Menarini, Merck Serono, EXCEMED, Novartis, Novo Nordisk, and Sanofi.

How You Can Reduce Your Risk Of Developing Heart Disease

To manage or reduce your chances of developing heart disease if youre living with diabetes, its important to maintain a healthy lifestyle and manage your diabetes effectively. Ways to do this include:

• Taking your medication to control diabetes as prescribed by your doctor
• Eating a varied diet of healthy foods
• Being physically active
• Managing your blood cholesterol and blood pressure levels
• Being smoke-free

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Certain Recipe For Heart Failure

Diabetes is tied to the blood system, and unchecked high glucose levels is a certain recipe for congestive heart failure.

People who have elevated blood sugar levels are 2-4 times more likely to develop heart failure than someone without diabetes.

Heart failure, a condition in which the heart fails to efficiently pump oxygenated blood through the body, also is a risk factor for diabetes.

Causes Of Type 2 Diabetes

Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. Exactly why this happens is unknown, although genetics and environmental factors, such as being overweight and inactive, seem to be contributing factors. Type 2 Diabetes Symptoms and causes Mayo Clinic Jan 9, 2019

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Diabetes And Your Heart

You can lower your risk for heart disease with lifestyle changes.

Diabetes and heart disease often go hand in hand. Learn how to protect your heart with simple lifestyle changes that can also help you manage diabetes.

Heart disease is very common and serious. Its the leading cause of death for both men and women in the United States. If you have diabetes, youre twice as likely to have heart disease or a stroke than someone who doesnt have diabetesand at a younger age. The longer you have diabetes, the more likely you are to have heart disease.

But the good news is that you can lower your risk for heart disease and improve your heart health by changing certain lifestyle habits. Those changes will help you manage diabetes better too.

Diabetes And Heart Failure Are Linked Treatment Should Be Too

Please note: This article was published more than two years ago, so some information may be outdated. If you have questions about your health, always contact a health care professional.

Having Type 2 diabetes or heart failure independently increases the risk for getting the other, and both often occur together, further worsening a patient’s health, quality of life and care costs, a new report says.

Many of the risk factors and mechanisms behind Type 2 diabetes and heart failure are similar, yet there’s a lack of guidance on how to care for people with both conditions, according to a scientific statement from the American Heart Association and the Heart Failure Society of America published Thursday in the journal Circulation.

Recent studies have found new treatments for diabetes may also improve heart failure outcomes, showing the interplay between the two conditions, the report says.

The statement summarizes what’s known about the inner workings of diabetes and heart failure and the best ways to treat the conditions when they occur simultaneously.

But it also encourages clinicians to coordinate the care and treatment of patients who have both conditions in “a thoughtful and cohesive way,” said Dr. Shannon Dunlay, who co-chaired the report’s writing committee.

Ideally, all the patient’s care teams would be aligned.

Since people who have either condition are at increased risk for developing the other, they should take proactive steps to improve their health, she said.

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Diabetes Hypertension And Heart Failure

Lowering blood pressure is widely recommended to reduce vascular risk in individuals with type 2 diabetes. Hypertension, and systolic hypertension in particular is strongly linked to cardiovascular disease and incident heart failure in patients with diabetes. Indeed, hypertension is widely considered to be the single most important modifiable risk factor for heart failure and long-term treatment of hypertension in the general population has been shown to reduce the risk of incident heart failure by approximately half . However, while strong data exists in the general population, there is no clear evidence that blood pressure lowering reduces new-onset heart failure events in patients with diabetes . One reason for this paradox may be the differential effects of different antihypertensive agents. For example, while the use of Diuretic-based antihypertensive therapy or RAAS blockers is associated with a lower risk of heart failure, the use of calcium channel agents or 1-blockade which effectively lower the blood pressure have a modestly increased of heart failure when compared with all other classes of antihypertensive medications . However, the demonstrated benefits with respect to cardiovascular and all cause mortality observed in the ADVANCE study, mean that blood pressure lowering in hypertensive patients with diabetes remains a priority.

Nonstandard Abbreviations And Acronyms:

EDA has consulted in the past for Novo Nordisk and Pfizer.

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Impact Of Diabetes On Heart Failure Outcomes

Approximately 25% of HF patients overall and 40% of hospitalized HF patients have DM . The presence of DM in HF patients is associated with an increased risk of death, hospitalization, and prolonged hospital stay . In the Effect of Candesartan for the Management of Patients with Chronic Heart Failure program DM was present in 28.4% of patients and was associated with increased risk of CV death or HF hospitalization in patients with both heart failure with preserved ejection fraction and heart failure with reduced ejection fraction . For all-cause mortality, the adjusted risk conferred by DM was similar in both HFrEF and HFpEF groups .

The European Society of Cardiology and Heart Failure Association Long-Term Registry, a multinational cohort of 9,428 outpatients with HF compared outcomes between patients with and without DM. Overall, those with DM had higher cumulative rates of 1-year all-cause death , CV death , and HF hospitalization . There was a significant and independent association between increasing glycosylated hemoglobin levels and risk of 1-year survival outcomes . Finally, in a large meta-analysis of 381,725 patients with acute and chronic HF over a median follow-up of 3 years, DM was associated with a higher risk of all-cause death , CV death , and hospitalization . The impact of DM on mortality and hospitalization was greater in patients with chronic as opposed to acute HF .

Heart Failure With Type 2 Diabetes Mellitus: Association Between Antihyperglycemic Agents Glycemic Control And Ejection Fraction

• 1Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
• 2Department of Medicine, Hospital Tengku Ampuan Rahimah, Ministry of Health Malaysia, Klang, Malaysia
• 3Department of Cardiology, Hospital Queen Elizabeth II, Ministry of Health, Kota Kinabalu, Malaysia
• 4Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia

Background: Heart failure is associated with type 2 diabetes mellitus . Antihyperglycemic drugs have interaction with heart failure among diabetic patients. To date, the data on real world use of diabetic medication in Malaysian heart failure patients with T2DM has not been elucidated.

Objective: This study aims to identify the prescribing pattern of antihyperglycemic regimens in HF patients with T2DM, and to investigate the association between glycemic control and other factors such as demographic and clinical characteristics with left ventricular ejection fraction in these patients.

Our findings reported metformin as the most commonly prescribed antihyperglycemic agent, sodium glucose linked transporter-2 inhibitor being under-prescribed, and detected poorly controlled diabetes in majority of patients with T2DM and HF. Understanding the prescribing pattern of antihyperglycemic agents supports the implementation of evidence-based treatment in HF patients with T2DM to improve patients’ outcomes.

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Demographic And Clinical Characteristics

Majority of the patients had HFpEF, 20.6% had HFmrEF, and 27.3% had HFrEF. The study population consisted of nearly three-quarters of male. As shown in Table 1, patients’ age was normally distributed with a mean ± standard deviation of 59.6 ± 12.0 years, with a minimum age of 25 and maximum age of 88 years old. LVEF was found to increase with advancing age. Patients from HFrEF group had the youngest mean age . The largest ethnic population in this study was Malay, followed by Indian, Chinese, and others. When we compared between the three LVEF subgroups, there was significant sex disparity in the population of HF patients with T2DM. More than 80% of male patients were in the HFmrEF and HFrEF categories while there were more than twice as many females in the HFpEF groups in comparison with HFmrEF or HFrEF groups. Sex was the only characteristic found to be significantly associated with LVEF status. Male HF patients were significantly more likely to have LVEF of 50% . There were no significant association between other demographic characteristics such as age and ethnicity with LVEF status across the three patient groups .

Table 1. Demographic and clinical characteristics of patients.

Biomarkers And Glycemic Markers For Hf And Diabetes

Glycemic markers for diabetes in people with HF

Diabetes is diagnosed by repetitive assessment of the glycemic parameters HbA1c or fasting plasma glucose in the 2019 ESC-EASD recommendations) . The 2006/2011 World Health Organization and 2019 American Diabetes Association recommendations defined the presence of diabetes when HbA1c is 6.5% and FPG is 7.0 mmol/L . Moreover, performing an oral glucose tolerance test is a well recommended tool since it detects postprandial hyperglycemia, a risk factor of CVD, and thus identifies a large number of undiagnosed patients with diabetes .

Natriuretic peptides

In recent years, the circulating biomarkers of the natriuretic peptide system have become increasingly important in relation to HF and, when elevated in the absence of prevalent HF, identify individuals with pre-HF at risk for progression to symptomatic disease . Cardiac stress induces the synthesis of a 108 amino acid long precursor peptide pro-BNP in myocytes which is split into a biologically active BNP and an inactive N-terminal peptide, NT-proBNP . Both BNP and NT-proBNP are viewed as useful biomarkers to support clinical judgement for the diagnosis of HF . In addition, NT-proBNP correlates with the HF risk in people with T2D and with adverse outcomes in HF subjects .

Troponin

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Managing Your Diabetes And Your Heart

We’ve talked about the link between high blood sugar levels and your heart health. But it’s not all down to blood sugars. Blood vessels are also damaged by high cholesterol and .

So you can help prevent damage to your blood vessels by looking after your:

• blood sugar levels
• blood pressure
• cholesterol

Getting your HbA1c, cholesterol and blood pressure checked at least once a year are part of the checks you should have if you have diabetes. These might be delayed or happen differently at the moment because of the coronavirus pandemic. Speak to your healthcare team if you are not sure how soon you need these tests again.

By managing these three things, you’ll be helping to manage your diabetes and protecting yourself against heart complications. But there are lots of other things you can do to reduce your risk of heart disease.

“Its all very well having your bloods taken but go back and ask about them what do the results mean? I make sure I get all my checks and by taking that control myself, I’m reducing my risk of developing these complications.”

Read Sarah’s story to find out what she’s doing to reduce her risk of developing complications

Study Strength And Limitation

In this study, real-time data such as antihyperglycemic agents, glycemic control, patients’ HF classification according to both LVEF and NYHA functional class were collected and analyzed, reflecting clinical practice in the actual situation. The exposure duration of patients to antihyperglycemic agents was well-defined, which was at least 3 months. Research site was selected based on patient population served, HF patient volume, and availability of expertise in echocardiography. There were several limitations in this study. Sampling of subjects from only one hospital implicates that the demonstrated characteristics of this study population might not accurately represent the entire Malaysian population. Also, due to the retrospective nature of the study design, there were incomplete information and missing data from some of the patients’ medical records, such as the duration of HF and T2DM, as well as patients’ renal and hepatic functions.

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