In June 2022, a report from the American Diabetes Association indicated that heart failure is a “underestimated complication of diabetes.” According to that report, up to 22% of individuals with diabetes will develop heart failure, and the prevalence of heart failure is increasing in the diabetes community.
The Relationship Between Heart Failure and Diabetes
Among individuals with diabetes, glucose (also known as blood sugar) does not move from the blood into the cells in the way it should. This results in elevated glucose and insulin levels, with insulin being a hormone that helps clear glucose from the blood. These elevations may contribute to the development of heart failure in some people with diabetes. “Elevated glucose levels and elevated insulin levels can cause damage at the molecular level to heart cells,” says Dr. Makarios.
But this is not the only connection between the two conditions. “Mechanically, there are several processes affecting individuals with diabetes that increase the risk of heart failure,” says Dr. James Januzzi, a professor of medicine at Harvard Medical School and a clinical cardiologist at Massachusetts General Hospital. Januzzi states that in addition to the increased risk of coronary artery disease, diabetes can cause direct injury to the heart muscle, resulting in stiffening and weakening that can develop into heart failure. Research has shown that diabetes is associated with decreased mitochondrial function, oxidative stress, inflammation, and increased formation of harmful compounds known as “advanced glycation end products,” all of which can contribute to the development of heart failure. “Diabetes is associated with a shift from glucose metabolism in the heart to the production of the sugar alcohol sorbitol, which may lead to cell death and cardiac dysfunction,” Januzzi explains. “We also know that individuals with diabetes are at higher risk for chronic kidney disease, which is an independent risk factor for heart failure.” For all these reasons, he says that having diabetes alone is now considered a major risk factor for heart failure.
Signs and Symptoms of Heart Failure
The symptoms of heart failure are similar whether or not the person has diabetes. Fatigue ranks high on the list, although this symptom may not be obvious at first. “A person may feel that they don’t have the same energy they used to have,” Januzzi says. Shortness of breath is another hallmark symptom of heart failure, but it may be difficult to detect if fatigue causes the person to reduce physical activity. “I often ask the patient if they feel short of breath and they say no, but that’s because they have reduced their activity,” he states. As heart failure progresses, these symptoms become more pronounced. For example, shortness of breath may appear even after very minimal physical exertion, such as climbing a few stairs.
“Another classic symptom is not just shortness of breath with exertion but shortness of breath when lying down or upon waking,” says Makarios. “This is due to fluid buildup in the lungs as a result of the heart being unable to pump blood as it should.” Fluid accumulation can also lead to swelling (or edema) in the legs or abdomen in individuals with heart failure, he states.
While these are the most common symptoms, other symptoms include wheezing, weakness, palpitations (fast or irregular heartbeat), nausea, weight gain, issues with thinking or concentration, and a persistent unexplained cough (which may be accompanied by white or pink phlegm). As heart failure progresses, all of these symptoms may become less obvious. “Fatigue may become so significant that a person cannot complete their daily activities,” says Makarios.
From
It is important to note that many cases of heart failure go through an early stage when there are no obvious symptoms. However, at this stage, the condition can be detected using certain specific blood tests. “We now have biomarkers that can identify early molecular changes in the heart that precede more obvious structural changes,” says Bob-Boussay. There are established drug treatments available to slow the progression of heart failure, and detecting the condition at this early stage when there are no symptoms can improve patient outcomes. On the other hand, some diabetes medications may contribute to the development of heart failure. If the condition is detected at an early stage, a person with diabetes may be able to stop using these medications before the condition progresses. “Early diagnosis can ensure that people with diabetes have access to the best treatments in a timely manner,” says Bob-Boussay.
Treatment Options
The primary standard treatments for heart failure are medications, and experts say that the medications they choose depend on the severity of the condition. “We look at something called the ejection fraction, or the heart’s pumping strength, to determine the appropriate treatment plan,” says Janouzi.
If the patient’s ejection fraction is low – meaning the heart is not pumping as strongly as it should – the treatment usually includes several classes of medications aimed at dilating blood vessels and improving blood flow. “There are four main classes of therapies that we recommend,” he says. These groups include beta-blockers, aldosterone antagonists, a medication called sacubitril/valsartan that dilates blood vessels, and what is known as SGLT-2 inhibitors, which not only lower blood pressure but also help reduce blood glucose levels. (SGLT-2 inhibitors are often used to treat diabetes even in the absence of heart failure.)
“For people who maintain a normal ejection fraction, which is the normal pumping strength, the treatment options are fewer,” says Janouzi. “However, recent clinical trials of SGLT-2 inhibitors have shown benefits for these individuals, so their use should now be considered in anyone with heart failure, especially in people with diabetes.”
“In my opinion, these medications are very important,” says Makarios about SGLT-2 inhibitors. “Initially, they were marketed as medications for diabetes because they have effects on lowering blood sugar levels, but clinical trials have shown they improve outcomes and reduce the risk of death from major cardiovascular events, including heart failure.” He notes that another new class of drugs called GLP-1 receptor agonists has also shown benefits in individuals with diabetes and heart failure, and they are likely to be used more frequently to treat these overlapping conditions.
Often, the medications used to treat heart failure in individuals with diabetes are the same medications prescribed for those without diabetes, but there is evidence suggesting they work better even in individuals with both conditions. “I tell my diabetic patients that they can expect a greater reduction in risk than someone without diabetes,” says Janouzi.
Aside from medications, lifestyle and behavioral changes can make a significant difference for people with heart failure. “This includes increasing exercise as much as possible,” says Janouzi. “It also includes paying attention to personal mood.” He notes that depression and anxiety are associated with worse outcomes for people with heart failure, so it is crucial to address these mental health challenges (such as therapy, for example) if they arise.
The system
“The dietary and weight loss aspects are important as well,” says Janouzi. “In our institution, we often recommend following a Mediterranean-style diet that includes more complex carbohydrates and a moderate amount of protein.” While there is a wealth of strong research supporting the benefits of the Mediterranean diet, he indicates that individuals with diabetes and heart failure should ideally work with a medical nutritionist or dietitian to create a customized dietary plan. “Each individual patient has a unique set of medical issues that need to be considered,” he states. There is no one-size-fits-all diet for those with diabetes and heart failure.
Preventing Heart Failure
While everyone should prioritize heart health, taking steps to reduce the risk of heart failure is especially important if you have been diagnosed with diabetes. “Even for those with relatively new diabetes, the disease may have been present for some time, and so the clock has already started counting down,” says Janouzi. “There’s no better time than now to focus on health and wellness.”
Managing your risk factors for heart failure is the first step, which means not smoking, above all, and also managing cholesterol, blood pressure, and blood sugar through a combination of diet, exercise, weight loss, and medication treatment. “I also encourage diabetes patients to educate themselves so they understand their condition and the early warning signs of heart failure,” says Janouzi. It’s still a good idea to stay informed about the latest information related to your disease, risk factors, treatment options, and screening options. “I always advise my patients to be their own advocates,” he adds.
Heart failure is a common complication among people with diabetes. But with the right plan, you and your healthcare team can take steps to prevent or effectively manage the condition.
Source: https://www.aol.com/know-heart-failure-diabetes-155348419.html
.lwrp .lwrp-list-row-container{
display: flex;
justify-content: space-between;
}
.lwrp .lwrp-list-row-container .lwrp-list-item{
width: calc(12% – 20px);
}
.lwrp .lwrp-list-item:not(.lwrp-no-posts-message-item){
}
.lwrp .lwrp-list-item img{
max-width: 100%;
height: auto;
object-fit: cover;
aspect-ratio: 1 / 1;
}
.lwrp .lwrp-list-item.lwrp-empty-list-item{
background: initial !important;
}
.lwrp .lwrp-list-item .lwrp-list-link .lwrp-list-link-title-text,
.lwrp .lwrp-list-item .lwrp-list-no-posts-message{
}@media screen and (max-width: 480px) {
.lwrp.link-whisper-related-posts{
}
.lwrp .lwrp-title{
}.lwrp .lwrp-description{
}
.lwrp .lwrp-list-multi-container{
flex-direction: column;
}
.lwrp .lwrp-list-multi-container ul.lwrp-list{
margin-top: 0px;
margin-bottom: 0px;
padding-top: 0px;
padding-bottom: 0px;
}
.lwrp .lwrp-list-double,
.lwrp .lwrp-list-triple{
width: 100%;
}
.lwrp .lwrp-list-row-container{
justify-content: initial;
flex-direction: column;
}
.lwrp .lwrp-list-row-container .lwrp-list-item{
width: 100%;
}
.lwrp .lwrp-list-item:not(.lwrp-no-posts-message-item){
}
.lwrp .lwrp-list-item .lwrp-list-link .lwrp-list-link-title-text,
.lwrp .lwrp-list-item .lwrp-list-no-posts-message{
};
}
Leave a Reply