The Effect of Hyperglycemia and Its Therapies on the Heart

Abstract

Diabetes mellitus (DM) has been identified as a risk factor for morbidity and mortality in heart failure. Although DM is a clear risk factor for the development of heart failure, the incidence of DM in patients who have heart failure is increased markedly above that of the general population. These observations lead to questions regarding the role of diabetes in the cause of heart failure. Epidemiologic studies have shown that persons with type 1 or type 2 DM are at increased risk of all forms of cardiovascular disease (CVD) affecting the heart, brain, and peripheral blood vessels [1–4]. The excess risk of both subclinical atherosclerosis and CVD actually begins in states of abnormal glucose regulation, including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and insulin resistance [5–8]. The slow, insidious development of the macrovascular and microvascular complications related to diabetes contribute to the fact that people with diabetes usually are not diagnosed with CVD until they have very extensive disease, and often their symptoms, which may be vague and nonspecific, are not recognized as manifestations of CVD [8–12].