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[Heart involvement in diabetic patients]
A Grimaldi1, I Gonzalez, F Bosquet
1Service de Diabétologie, Hôpital Pitié-Salpêtrière, Paris.
Insights
Diabetic cardiomyopathy involves premature aging of the heart muscle, increasing risks of heart disease and silent ischemia. Management requires addressing risk factors and early detection in diabetic patients.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Context:
- Diabetic cardiomyopathy is linked to premature myocardial aging, reduced compliance, and altered catecholamine sensitivity.
- Cardiac complications, particularly coronary artery disease, are highly prevalent and severe in diabetic populations, contributing significantly to mortality.
- Neuropathic denervation and other metabolic factors like hypertriglyceridemia may contribute to cardiac dysfunction in diabetes.
Purpose:
- To review the pathophysiology and clinical implications of cardiac complications in diabetes mellitus.
- To highlight the increased incidence and severity of coronary artery disease in diabetic patients.
- To emphasize the importance of managing cardiovascular risk factors and screening for silent ischemia.
Summary:
- Diabetic cardiomyopathy exhibits features of premature aging, impacting myocardial function and potentially exacerbated by hypertension or ischemia.
- Coronary artery disease is a leading cause of death in diabetics, with higher mortality rates, especially in women.
- The role of abnormal lipid metabolism, hyperglycemia, hypertension, coagulation disorders, and hyperinsulinism requires further elucidation, alongside optimal risk factor targets for diabetics.
Impact:
- Underscores the critical need for primary prevention and aggressive management of cardiovascular risk factors in diabetic individuals.
- Recommends systematic screening for silent myocardial ischemia, which is significantly more common in diabetes.
- Promotes early detection through various diagnostic modalities for diabetic patients with or at risk for coronary artery disease.
Abstract:
Diabetic cardiomyopathy appears to be due to "premature ageing" of the myocardium which loses some of its compliance and becomes less sensitive to catecholamines. The condition seems to be severe mainly in those frequent cases where it is associated with hypertensive and/or ischaemic cardiomyopathy. Neuropathic denervation of the heart, usually partial and predominantly affecting the parasympathetic system, might play a part in the myocardial dysfunction. It has been held responsible for sudden death, but its real consequences in diabetic patients remain to be assessed. Coronary artery disease is the most common cardiac complication of diabetes mellitus: it accounts for 50 per cent of deaths among noninsulin-dependent, and 25 per cent among insulin-dependent diabetic subjects. Its incidence does not seem to decline and its severity, notably in women, is demonstrated by a mortality rate that is twice as high as that observed in the non-diabetic population; hence the importance of primary prevention and treatment of risk factors. However, the specificity to abnormal lipid metabolism, notably hypertriglyceridaemia, the potentiation by chronic hyperglycaemia of the harmful effects of arterial hypertension, and the possible responsibility of coagulation disorders and hyperinsulinism are points that have not yet been elucidated. We still do not know whether the objectives to be attained in terms of plasma cholesterol, triglycerides and fibrinogen levels, as well as of blood pressure values, should be different in diabetic and non-diabetic subjects. In any case, the treatment of risk factors should be accompanied by a systematic search for silent ischaemia which is 2 to 3 times more frequent among diabetic patients. Detection of silent ischaemia by electrocardiography during exercise and/or Holter recordings, and by echocardiography and/or thallium scintigraphy should be performed not only in diabetic patients with coronary artery disease but also to those with other risk factors or albuminuria.