Heart Failure and Metabolic Factors
The metabolic features of heart failure risk have been described in both epidemiological and pathophysiological studies. As impaired glucose metabolism and overt diabetes are closely associated with heart failure risk, the influence of antidiabetic drugs
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Heart Failure and Metabolic Factors Peter M. Nilsson, John Molvin, and Martin Magnusson
8.1
Introduction
The increasing prevalence of coronary heart disease (CHD) and type 2 diabetes (DM2) is partly due to the aging European population and partly due to increased prevalence of risk factors that interact to increase the risk of heart failure (HF) [1, 2]. This could be due to either a common antecedent (genetics, early life programming) or that of hypertension, a well-established risk factor for HF in itself, which is also associated with impaired glucose metabolism in many subjects and often coexists with obesity [3]. Therefore, new ways are explored to reduce the risk of HF by the use of antidiabetic drugs and lifestyle interventions to control glucometabolic status that could also improve hemodynamics and blood pressure control, as stated in European guidelines [4]. In this review we would like to provide an overview of the epidemiology and pathophysiology, as well as treatment aspects, of HF in relation to impaired metabolic control, more specifically hyperglycemia but also other metabolic abnormalities (Table 8.1). P. M. Nilsson (*) Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden e-mail: [email protected] J. Molvin Department of Cardiology, Skane University Hospital, Malmö, Sweden Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden e-mail: [email protected] M. Magnusson Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden Department of Cardiology, Skane University Hospital, Malmö, Sweden Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden e-mail: [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_8
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Table 8.1 Metabolic factors associated with increased risk of heart failure or with adverse prognosis in patients with established heart failure
8.2
• Hyperglycemia, glucotoxicity • Insulin resistance • Lipids abnormalities, lipotoxicity • Free fatty acid metabolism of cardiomyocytes • Hemochromatosis • Hyperuricemia • Vitamin deficiency (vitamin B1, thiamin) • Inborn error of metabolism (i.e., glycogen storage disease)
Diabetes and Heart Failure Risk: Epidemiology
In the Framingham cohort, diabetes was associated with twofold risk of heart failure for men and a fivefold increased risk for women [5]. In women, diabetes appears to be an even stronger risk factor for heart failure than a history of coronary heart disease [6]. As stated above, both the incidence and prevalence of HF are significantly higher in the diabetic population, and it also carries a considerably worse prognosis [7]. Not only manifest diabetes poses a significant risk. The structural and functional harmful effects on the cardiovascular system induced by glucometabolic disturbances represent a contin
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