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Minerva Cardiology and Angiology 2022 June;70(3):344-56

DOI: 10.23736/S2724-5683.22.05967-1


lingua: Inglese

Diabetes mellitus and heart failure: an update on pathophysiology and therapy

Nicola POTERE 1, 2, Marco G. DEL BUONO 3, 4, Alessandra VECCHIÉ 5, Ettore PORRECA 1, 2, Antonio ABBATE 3, Francesco DENTALI 6, Aldo BONAVENTURA 5

1 Department of Medicine and Ageing Sciences, G. D’Annunzio University, Chieti, Chieti-Pescara, Italy; 2 Department of Innovative Technologies in Medicine and Dentistry, G. D’Annunzio University, Chieti, Chieti-Pescara, Italy; 3 Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; 4 Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy; 5 Department of General Medicine1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy; 6 Department of Medicine and Surgery, Insubria University, Varese, Italy

Diabetes mellitus (DM) is frequent among heart failure (HF) patients with a further projected increase in prevalence in next years. DM promotes the development of both HF with reduced (HFrEF) and preserved ejection fraction (HFpEF) through different mechanisms. As the general prevalence of both DM and HF is growing worldwide, it is important to define the pathophysiologic mechanisms driving the development of HF in DM patients. These include changes in the cardiac metabolism, mitochondrial dysfunction, impairment in insulin signaling, maladaptive inflammation, coronary microvascular dysfunction, endoplasmic reticulum stress, autophagy suppression, and structural changes, among the main ones. In recent years, novel glucose-lowering treatments, especially sodium-glucose cotransporter 2 inhibitors (SGLT-2is), have shown a strikingly positive impact on the natural history of HF. This has led to a progressive change in choosing SGLT-2is in DM patients at high risk for cardiovascular disease, supported by recent guidelines. The knowledge about novel pathophysiological mechanisms linking DM and HF may open the way to the development of new targeted therapies in the future. In this review, we will summarize general aspects dealing with incidence, prevalence, and pathophysiology of DM in HF patients. As well, we discuss the therapeutic targets to reduce the disease burden and the current evidence of glucose-lowering drugs in patients with DM and HF.

KEY WORDS: Heart failure; Diabetes mellitus, type 2; Pathophysiology; Therapy; Sodium-glucose transporter 2 inhibitors

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