Diabetes: a driver for heart failure
Diabetes: a driver for heart failure
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DOI：
10.1136/hrt.2009.183624
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发表时间：
2011-05-01
期刊：
影响因子：
5.7
通讯作者：
van der Horst, Iwan C. C.
中科院分区：
文献类型：
--
作者：
Voors, Adriaan A.;van der Horst, Iwan C. C.
糖尿病和心力衰竭 (HF) 经常并存，由于全球范围内患有糖尿病或心力衰竭的人数不断增加，糖尿病性心力衰竭患者的数量预计将呈指数级增长。与没有心力衰竭的糖尿病患者相比，患有糖尿病和心力衰竭的患者的临床结果较差。此外，患有糖尿病的心力衰竭患者与没有糖尿病的心力衰竭患者具有不同的特征。这一观察结果表明，糖尿病可能导致心力衰竭的发生和进展。其他几项研究结果支持糖尿病是心力衰竭的驱动因素这一概念。糖尿病可能会通过增加动脉粥样硬化疾病的风险来增加发生心力衰竭的风险。此外，糖尿病直接影响心脏的功能和结构，例如通过胰岛素信号传导改变和线粒体功能障碍、晚期糖基化终末产物（AGE）增加（沉积）、氧化应激和脂质积累。针对糖尿病和心力衰竭存在多种治疗指南，但针对糖尿病合并心力衰竭的具体治疗建议很少。此外，对于合并心力衰竭的患者，不推荐某些糖尿病治疗方案。本文概述了目前关于心力衰竭和糖尿病患者的流行病学、病理生理学和治疗的知识和理解。 糖尿病心力衰竭患者的流行病学、临床特征和结果 糖尿病患者心力衰竭的患病率 在一般人群中，男性心力衰竭和糖尿病患者的患病率估计为 0.5%，女性为 0.4%。 1 糖尿病患者中心力衰竭的患病率在 9% 至 22% 之间，与一般人群相比要高得多。在 Kaiser Permanente 西北分部的出院数据库中，糖尿病患者的心衰患病率为 11.8%，而非糖尿病患者的心衰患病率为 4.5% (n= 1566)。 w1 70 岁及以上女性的患病率最高。 w2 糖尿病患者无症状舒张功能障碍的患病率可能更高，估计在 52-60% 之间。 w3 w4 并非所有舒张功能不全的患者都会出现心力衰竭，但射血分数保留的糖尿病患者中心力衰竭的患病率可能更为常见，但尚未明确（约 25%）。
Diabetes and heart failure (HF) often co-exist, and since the number of people with either diabetes or HF is increasing worldwide, the number of diabetic HF patients is expected to grow exponentially. Patients with diabetes and HF have a poorer clinical outcome compared to diabetic patients without HF. Also, HF patients with diabetes have different characteristics compared to HF patients without diabetes. This observation suggests that diabetes might contribute to the onset and progression of HF. Several other findings support the concept that diabetes is a driver for HF. Diabetes might increase the risk of developing HF through the increased risk of atherosclerotic disease. In addition, diabetes directly influences function and structure of the heartdfor example, through altered insulin signalling and mitochondrial dysfunction, increased (deposition of) advanced glycation end products (AGEs), oxidative stress, and lipid accumulation. Several treatment guidelines exist for diabetes and HF, but the specific treatment suggestions for diabetics with HF are sparse. Moreover, some treatment options for diabetes are not recommended for those with concomitant HF. This article provides an overview of the current knowledge and understanding regarding the epidemiology, pathophysiology, and treatment of patients with HF and diabetes.EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, AND OUTCOME OF HF PATIENTS WITH DIABETES Prevalence of HF in patients with diabetes In the general population the prevalence of patients with both HF and diabetes is estimated at 0.5% in men and 0.4% in women. 1 In patients with diabetes the prevalence of HF is between 9e22%, which is much higher compared to the general population. In a hospital discharge database of the Kaiser Permanente Northwest Division the prevalence of HF was 11.8% in patients with diabetes compared to 4.5% in patients without diabetes (n= 1566). w1 The prevalence is highest in women aged 70years and older. w2 The prevalence of asymptomatic diastolic dysfunction in patients with diabetes is probably higher, and estimated to be between 52e60%. w3 w4 Not all patients with diastolic dysfunction have HF, but the prevalence of HF with preserved ejection fraction in patients with diabetes is probably more common but less well established (approximately 25%).