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A Paradigm Shift in the Treatment of Type 2 Diabetes and Heart Failure

Motoaki Sano1

  • 1Department of Cardiology, Keio University School of Medicine.

Journal of Atherosclerosis and Thrombosis
|June 30, 2020
PubMed

Insights

Diabetic patients face high heart failure risk despite controlled risk factors. Current guidelines are insufficient, highlighting the need for new approaches targeting kidney-brain-heart interactions.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Diabetic patients have a higher risk of heart failure (HF) even with controlled myocardial infarction (MI) risk factors.
  • Current treatment guidelines primarily focus on MI prevention and are inadequate for preventing HF in diabetes.

Purpose of the Study:

  • To investigate the mechanisms underlying HF development in diabetic patients.
  • To advocate for updated treatment guidelines based on a comprehensive understanding of HF pathophysiology in diabetes.

Main Methods:

  • Observational study analyzing risk factors and HF development in diabetic individuals.
  • Review of clinical evidence, including the impact of sodium-glucose-coupled transporter (SGLT)-2 inhibitors.

Main Results:

  • Despite optimal management of blood glucose, blood pressure, lipids, and smoking, HF incidence remains elevated in diabetics.
  • The pathological kidney-brain-heart coupling contributes to HF by shifting the hemodynamic set point towards cardiac overload.
  • Sodium-glucose-coupled transporter (SGLT)-2 inhibitors demonstrate efficacy in slowing chronic kidney disease progression and reducing HF hospitalizations and mortality.

Conclusions:

  • Current MI-centric guidelines are insufficient for preventing HF in diabetic patients.
  • A holistic view of HF pathophysiology, emphasizing the renocardiac syndrome and kidney-brain-heart axis, is crucial.
  • Targeting the kidney-brain-heart axis may offer novel therapeutic strategies for diabetic HF.

Keywords:
Chronic kidney diseaseHeart failureKidney-brain-heart couplingRenin-angiotensin aldosterone systemSGLT2 inhibitorSympathetic nerve system

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