Diabetes mellitus and congestive heart failure

Congestive heart failure (CHF) is the final stage of cardiovascular disease and one of the leading causes of death. CHF develops in patients with the chronic coronary syndrome, hypertension, myocarditis, endocarditis, pericarditis, and other diseases. The prevalence of CHF in recent years is growing steadily and is about 2% in the adult population. Among the factors that worsen the prognosis of CHF is diabetes mellitus (DM). Type 2 DM is an independent risk factor for heart failure (HF), and fasting plasma glucose and increased glycated hemoglobin A1c are significantly associated with an increased risk of HF. This review article summarizes the existing literature on the current state of the problem of DM and CHF. In particular, there are considered the issues related to the features of myocardial damage in type 2 DM, DM as a risk factor for HF, subclinical myocardial disorders in diabetic patients, HF as a risk factor for DM; pathophysiological features of DM and HF; classification of CHF (according to the New York Heart Association, the American College of Cardiology Foundation/American Heart Association, the European Society of Cardiology); diagnosis of CHF with preserved, reduced and mildly reduced left ventricular ejection fraction; principles of pathogenetic therapy of HF in DM, in particular, the appointment of drugs that affect the renin-angiotensin-aldosterone system (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers); sacubitril/valsartan; beta-adrenergic receptor blockers, mineralocorticoid receptor antagonists, sinus node inhibitors, sodium-glucose cotransporter type 2 inhibitors, diuretics. Treatment of a patient with DM and HF will be successful only if adequate and safe antidiabetic therapy is prescribed, on the one hand, and metabolically neutral pharmacological therapy, on the other.