Diabetes mellitus and chronic heart failure: the current state of problem

Epidemiologic and clinical data have shown that the prevalence of chronic heart failure (CHF) in patients with diabetes mellitus (DM) is very high, and the prognosis for patients with CHF is worse in those with diabetes than in those without diabetes. Today, DM and CHF acquire the status of the epidemic of the XXI century.The article presented data on the development mechanisms and the features of CHF in patients with DM. Between DM and CHF there is a pathogenetic relationship. Insulin resistance and compensatory hyperinsulinemia play a key role in the pathogenesis of DM type 2. Violation of myocardial remodeling in DM type 2 is caused by a combination of factors associated with diabetic cardiomyopathy, reduction of the metabolic activity of cardiomyocytes, insufficient glucose transport into cells, endothelial dysfunction, diabetic macro and microangiopathy, myocardial fibrosis leading to development of CHF.The possibilities of therapy of anti-diabetic drugs in patients with DM type 2 and CHF have been presented and analyzed. The spectrum of available anti-diabetic drugs is extremely wide, ranging from the classical (insulin, biguanides, sulphonylureas) to the most recent agents (glitazones, DPP-4 inhibitors, sodium glucose cotransport-2 inhibitors). The cardiovascular effects of these drugs are multiple, their knowledge is important in the everyday practice, as the use of safe drugs regarding of CHF is preferred. During treatment it is important to continuously monitor of dynamics of the signs of heart decompensation.