Cardiometabolic Care: Assessing Patients with Diabetes Mellitus with No Overt Cardiovascular Disease in the Light of Heart Failure Development Risk

Q: What is the clinical evidence from this study?

Study design: Review. Population: Diabetes mellitus at risk for heart failure. Intervention: Multimodal risk stratification (imaging, natriuretic peptides) and cardioprotective strategies (lifestyle modification, SGLT2 inhibitors, RAS antagonists). Primary outcome: Heart failure development and cardiovascular outcomes.

Christina Chrysohoou; Christos Fragoulis; Ioannis Leontsinis; Ioannis Gastouniotis; Dimitra Fragouli; Maximos Georgopoulos; Emmanouil Mantzouranis; Marina Noutsou; Konstantinos Tsioufis

doi:10.3390/nu15061384

March 13, 2023NutrientsOpen Access

Cardiometabolic Care: Assessing Patients with Diabetes Mellitus with No Overt Cardiovascular Disease in the Light of Heart Failure Development Risk

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Key result

Targeted imaging, biomarkers, lifestyle changes, and SGLT2 inhibitors improve heart failure prevention in diabetes.

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Why the study?

Assessing the risk of heart failure development in patients with diabetes mellitus is valuable for identifying both high-risk and low-risk subpopulations.

Structured PICO

P

Population

Patients with diabetes mellitus and no overt cardiovascular disease who are at risk of developing heart failure across the left ventricular ejection fraction spectrum.

I

Intervention

Risk assessment using deformation imaging (speckle-tracking echocardiography, cardiac MRI) and biomarkers (NT-proBNP, BNP), combined with cardioprotective interventions including lifestyle modification (Mediterranean diet, DASH diet, weight loss, physical activity, smoking cessation) and pharmacotherapy (SGLT2 inhibitors, ACE inhibitors, ARBs).

O

Outcome

Development of heart failure (including HFpEF, HFmEF, and HFrEF), heart failure hospitalization, and cardiovascular mortality.

This narrative review highlights the shared metabolic pathways between diabetes mellitus and heart failure, advocating for early risk stratification using advanced cardiac imaging and natriuretic peptides alongside proactive lifestyle and pharmacological interventions (such as the Mediterranean diet, SGLT2 inhibitors, and RAS inhibitors) to prevent heart failure development.

Limitations

The development of a standardized strategy to screen and intervene in patients at risk of developing heart failure is challenging due to different definitions of heart failure risk, heterogeneity of prevalence in different populations, variable duration of subclinical course, and variable interventions.
Three-dimensional speckle-tracking deformation measurements require regular cardiac cycles and show a wide range of correlation with tagged cardiac MRI.
Transthoracic echocardiography cannot estimate epicardial adipose tissue volume and has relatively poor inter-observer and intra-observer variability.
Standardizing a screening and intervention strategy for heart failure risk is challenging due to heterogeneous definitions of risk, variable subclinical course duration, and differing population prevalences.
Further studies are needed to determine the cost-effectiveness of natriuretic peptide screening and its impact on quality of life and mortality.
Three-dimensional speckle-tracking echocardiography requires regular cardiac cycles and exhibits a wide range of correlation with gold-standard tagged cardiac MRI.
Transthoracic echocardiography cannot measure epicardial adipose tissue volume and has relatively poor inter-observer and intra-observer variability.

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Implication

May support risk stratification in diabetes; leaves open prospective validation of integrated strategies.

Abstract

The mechanisms leading to the development of heart failure (HF) in diabetes mellitus (DM) patients are multifactorial. Assessing the risk of HF development in patients with DM is valuable not only for the identification of a high-risk subgroup, but also equally important for defining low-risk subpopulations. Nowadays, DM and HF have been recognized as sharing similar metabolic pathways. Moreover, the clinical manifestation of HF can be independent of LVEF classification. Consequently, approaching HF should be through structural, hemodynamic and functional evaluation. Thus, both imaging parameters and biomarkers are important tools for the recognition of diabetic patients at risk of HF manifestation and HF phenotypes, and arrhythmogenic risk, and eventually for prognosis, aiming to improve patients' outcomes utilizing drugs and non-pharmaceutical cardioprotective tools such as diet modification.

Discussion

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Cite This Study

Chrysohoou et al. (2023) conducted a review in Diabetes mellitus at risk for heart failure. Multimodal risk stratification (imaging, natriuretic peptides) and cardioprotective strategies (lifestyle modification, SGLT2 inhibitors, RAS antagonists) was evaluated on Heart failure development and cardiovascular outcomes. Structural imaging, natriuretic peptides, lifestyle modifications, and SGLT2 inhibitors aid in risk stratification and prevention of heart failure in patients with diabetes mellitus.

synapsesocial.com/papers/6a706925e36a167817e23012 https://doi.org/10.3390/nu15061384

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Cardiometabolic Care: Assessing Patients with Diabetes Mellitus with No Overt Cardiovascular Disease in the Light of Heart Failure Development Risk

Figures

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiometabolic Care: Assessing Patients with Diabetes Mellitus with No Overt Cardiovascular Disease in the Light of Heart Failure Development Risk

Figures

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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