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      Diabetic cardiomyopathy

      review-article
      Author(s): * , † , † , ‡ ,   † , † , † , †
      Publication date (Electronic):
      Journal: Clinical Science (London, England : 1979)
      Publisher: Portland Press Ltd.
      Keywords: diabetic cardiomyopathy, heart failure, hyperglycaemia, Type 2 diabetes, ACE, angiotensin-converting enzyme, ACEI, ACE inhibitor, AGE, advanced glycosylation end-product, AngII, angiotensin II, AT1, AngII type 1 receptor, ARB, AT1 receptor blocker, BK, bradykinin, BNP, brain natriuretic peptide, BP, blood pressure, B1R, B1-receptor, B2R, B2-receptor, CHARM, Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity, CHS, Cardiovascular Health Study, CTGF, connective tissue growth factor, DAG, diacylglycerol, DGK, DAG kinase, DPP-4, dipeptidyl peptidase-4, EF, ejection fraction, ERK, extracellular-signal-regulated kinase, ET, endothelin, FA, fatty acid, GLP-1, glucagon-like peptide-1, GLUT4, glucose transporter 4, HbA1c, glycated haemoglobin, HF, heart failure, HFNEF, HF with a normal EF, HIF, hypoxia-inducible factor, KLK, kallikrein, hKLK, human KLK, KKS, KLK–kinin system, LV, left ventricular, LVED, left ventricular end-diastole, LVH, LV hypertrophy, LVM, LV mass, LVMI, LVM index, MESA, Multi-Ethnic Study of Atherosclerosis, MHC, myosin heavy chain, MI, myocardial infarction, MR, magnetic resonance, MRI, MR imaging, NCX, Na2+/Ca2+ exchange, NEFA, non-esterified FA, NF-κB, nuclear factor κB, NYHA, New York Heart Association, PARP, poly(ADP-ribose) polymerase, PKC, protein kinase C, PMCA, plasma-membrane Ca2+-ATPase, QOL, quality-of-life, RAS, renin–angiotensin system, RAAS, renin–angiotensin–aldosterone system, RAGE, receptor for AGEs, ROS, reactive oxygen species, RR, relative risk, RV, right ventricular, RyR, ryanodine receptor, SERCA, sarcoplasmic/endoplasmic reticulum Ca2+-ATPase, SHS, Strong Heart Study, SOLVD, Studies of Left Ventricular Dysfunction, SR, sarcoplasmic reticulum, STZ, streptozotocin, TDI, tissue Doppler imaging, TGF-β1, transforming growth factor-β1, TUNEL, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling, TZD, thiazolidinedione, UKPDS, UK Prospective Diabetes Study, VEGF, vascular endothelial growth factor, V̇O2max, maximal oxygen consumption

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          Abstract

          Diabetic cardiomyopathy is a distinct primary disease process, independent of coronary artery disease, which leads to heart failure in diabetic patients. Epidemiological and clinical trial data have confirmed the greater incidence and prevalence of heart failure in diabetes. Novel echocardiographic and MR (magnetic resonance) techniques have enabled a more accurate means of phenotyping diabetic cardiomyopathy. Experimental models of diabetes have provided a range of novel molecular targets for this condition, but none have been substantiated in humans. Similarly, although ultrastructural pathology of the microvessels and cardiomyocytes is well described in animal models, studies in humans are small and limited to light microscopy. With regard to treatment, recent data with thiazoledinediones has generated much controversy in terms of the cardiac safety of both these and other drugs currently in use and under development. Clinical trials are urgently required to establish the efficacy of currently available agents for heart failure, as well as novel therapies in patients specifically with diabetic cardiomyopathy.

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          The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial.

          HJ Dargie, P. Lechat (1999)
          In patients with heart failure, beta-blockade has improved morbidity and left-ventricular function, but the impact on survival is uncertain. We investigated the efficacy of bisoprolol, a beta1 selective adrenoceptor blocker in decreasing all-cause mortality in chronic heart failure. In a multicentre double-blind randomised placebo-controlled trial in Europe, we enrolled 2647 symptomatic patients in New York Heart Association class III or IV, with left-ventricular ejection fraction of 35% or less receiving standard therapy with diuretics and inhibitors of angiotensin-converting enzyme. We randomly assigned patients bisoprolol 1.25 mg (n=1327) or placebo (n=1320) daily, the drug being progressively increased to a maximum of 10 mg per day. Patients were followed up for a mean of 1.3 years. Analysis was by intention to treat. CIBIS-II was stopped early, after the second interim analysis, because bisoprolol showed a significant mortality benefit. All-cause mortality was significantly lower with bisoprolol than on placebo (156 [11.8%] vs 228 [17.3%] deaths with a hazard ratio of 0.66 (95% CI 0.54-0.81, p<0.0001). There were significantly fewer sudden deaths among patients on bisoprolol than in those on placebo (48 [3.6%] vs 83 [6.3%] deaths), with a hazard ratio of 0.56 (0.39-0.80, p=0.0011). Treatment effects were independent of the severity or cause of heart failure. Beta-blocker therapy had benefits for survival in stable heart-failure patients. Results should not, however, be extrapolated to patients with severe class IV symptoms and recent instability because safety and efficacy has not been established in these patients.
          Article 0 comments Cited 361 times – based on 0 reviews     Review now
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            Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators.

            S Yusuf, G. Dagenais, J Pogue … (2000)
            Observational and experimental studies suggest that the amount of vitamin E ingested in food and in supplements is associated with a lower risk of coronary heart disease and atherosclerosis. We enrolled a total of 2545 women and 6996 men 55 years of age or older who were at high risk for cardiovascular events because they had cardiovascular disease or diabetes in addition to one other risk factor. These patients were randomly assigned according to a two-by-two factorial design to receive either 400 IU of vitamin E daily from natural sources or matching placebo and either an angiotensin-converting-enzyme inhibitor (ramipril) or matching placebo for a mean of 4.5 years (the results of the comparison of ramipril and placebo are reported in a companion article). The primary outcome was a composite of myocardial infarction, stroke, and death from cardiovascular causes. The secondary outcomes included unstable angina, congestive heart failure, revascularization or amputation, death from any cause, complications of diabetes, and cancer. A total of 772 of the 4761 patients assigned to vitamin E (16.2 percent) and 739 of the 4780 assigned to placebo (15.5 percent) had a primary outcome event (relative risk, 1.05; 95 percent confidence interval, 0.95 to 1.16; P=0.33). There were no significant differences in the numbers of deaths from cardiovascular causes (342 of those assigned to vitamin E vs. 328 of those assigned to placebo; relative risk, 1.05; 95 percent confidence interval, 0.90 to 1.22), myocardial infarction (532 vs. 524; relative risk, 1.02; 95 percent confidence interval, 0.90 to 1.15), or stroke (209 vs. 180; relative risk, 1.17; 95 percent confidence interval, 0.95 to 1.42). There were also no significant differences in the incidence of secondary cardiovascular outcomes or in death from any cause. There were no significant adverse effects of vitamin E. In patients at high risk for cardiovascular events, treatment with vitamin E for a mean of 4.5 years had no apparent effect on cardiovascular outcomes.
            Article 0 comments Cited 247 times – based on 0 reviews     Review now
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              Effects of glucagon-like peptide-1 in patients with acute myocardial infarction and left ventricular dysfunction after successful reperfusion.

              Lazaros A Nikolaidis, Sunil V. Mankad, George Sokos … (2004)
              Glucose-insulin-potassium infusions are beneficial in uncomplicated patients with acute myocardial infarction (AMI) but are of unproven efficacy in AMI with left ventricular (LV) dysfunction because of volume requirements associated with glucose infusion. Glucagon-like peptide-1 (GLP-1) is a naturally occurring incretin with both insulinotropic and insulinomimetic properties that stimulate glucose uptake without the requirements for concomitant glucose infusion. We investigated the safety and efficacy of a 72-hour infusion of GLP-1 (1.5 pmol/kg per minute) added to background therapy in 10 patients with AMI and LV ejection fraction (EF) 1.63+/-0.09, P 2.02+/-0.11, P<0.01) compared with control subjects. The benefits of GLP-1 were independent of AMI location or history of diabetes. GLP-1 was well tolerated, with only transient gastrointestinal effects. When added to standard therapy, GLP-1 infusion improved regional and global LV function in patients with AMI and severe systolic dysfunction after successful primary angioplasty.
              Article 0 comments Cited 204 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Sci (Lond)
                Journal ID (pmc): cls
                Journal ID (publisher-id): CS
                Title: Clinical Science (London, England : 1979)
                Publisher: Portland Press Ltd.
                ISSN (Print): 0143-5221
                ISSN (Electronic): 1470-8736
                Publication date (Electronic): 15 April 2009
                Publication date (Print): 1 May 2009
                Volume: 116
                Issue: Pt 10
                Pages: 741-760
                Affiliations
                *The Manchester Heart Centre, Manchester Royal Infirmary, Manchester M13 9WL, U.K.
                †Cardiovascular Research Group, Department of Medicine, Manchester Royal Infirmary and University of Manchester, Manchester M13 9NT, U.K.
                ‡The Bristol Heart Institute, Bristol Royal Infirmary and University of Bristol, Bristol BS1 3NU, U.K.
                Author notes
                Correspondence: Professor Rayaz A. Malik (email Rayaz.A.Malik@ 123456man.ac.uk ).
                Article
                Publisher ID: cs1160741
                DOI: 10.1042/CS20080500
                PMC ID: 2782307
                PubMed ID: 19364331
                SO-VID: 035f938e-592e-4eaf-9d7c-b033b91a7bd3
                Copyright © © 2009 The Author(s) The author(s) has paid for this article to be freely available under the terms of the Creative Commons Attribution Non-Commercial Licence (http://creativecommons.org/licenses/by-nc/2.5/) which permits unrestricted non-commercial use, distribution and reproduction in any medium, provided the original work is properly cited.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 2 October 2008
                Date revision received : 2 December 2008
                Date accepted : 23 December 2008
                Page count
                Figures: 2, Tables: 2, References: 209, Pages: 20
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Medicine
                Keywords: ef, ejection fraction,v̇o2max, maximal oxygen consumption,type 2 diabetes,raas, renin–angiotensin–aldosterone system,hyperglycaemia,mri, mr imaging,arb, at1 receptor blocker,hif, hypoxia-inducible factor,fa, fatty acid,mesa, multi-ethnic study of atherosclerosis,rage, receptor for ages,qol, quality-of-life,ctgf, connective tissue growth factor,lvmi, lvm index,solvd, studies of left ventricular dysfunction,hba1c, glycated haemoglobin,nefa, non-esterified fa,angii, angiotensin ii,tzd, thiazolidinedione,shs, strong heart study,serca, sarcoplasmic/endoplasmic reticulum ca2+-atpase,nf-κb, nuclear factor κb,lvh, lv hypertrophy,vegf, vascular endothelial growth factor,ace, angiotensin-converting enzyme,at1, angii type 1 receptor,pkc, protein kinase c,hfnef, hf with a normal ef,klk, kallikrein,et, endothelin,mhc, myosin heavy chain,glut4, glucose transporter 4,tunel, terminal deoxynucleotidyl transferase-mediated dutp nick-end labelling,rv, right ventricular,parp, poly(adp-ribose) polymerase,nyha, new york heart association,ncx, na2+/ca2+ exchange,dpp-4, dipeptidyl peptidase-4,age, advanced glycosylation end-product,ryr, ryanodine receptor,sr, sarcoplasmic reticulum,erk, extracellular-signal-regulated kinase,kks, klk–kinin system,pmca, plasma-membrane ca2+-atpase,mi, myocardial infarction,lved, left ventricular end-diastole,b1r, b1-receptor,acei, ace inhibitor,bk, bradykinin,rr, relative risk,lv, left ventricular,ras, renin–angiotensin system,bp, blood pressure,chs, cardiovascular health study,hf, heart failure,dag, diacylglycerol,heart failure,bnp, brain natriuretic peptide,b2r, b2-receptor,hklk, human klk,ukpds, uk prospective diabetes study,mr, magnetic resonance,tdi, tissue doppler imaging,diabetic cardiomyopathy,glp-1, glucagon-like peptide-1,dgk, dag kinase,charm, candesartan in heart failure: assessment of reduction in mortality and morbidity,ros, reactive oxygen species,stz, streptozotocin,lvm, lv mass,tgf-β1, transforming growth factor-β1
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: ef, ejection fraction, v̇o2max, maximal oxygen consumption, type 2 diabetes, raas, renin–angiotensin–aldosterone system, hyperglycaemia, mri, mr imaging, arb, at1 receptor blocker, hif, hypoxia-inducible factor, fa, fatty acid, mesa, multi-ethnic study of atherosclerosis, rage, receptor for ages, qol, quality-of-life, ctgf, connective tissue growth factor, lvmi, lvm index, solvd, studies of left ventricular dysfunction, hba1c, glycated haemoglobin, nefa, non-esterified fa, angii, angiotensin ii, tzd, thiazolidinedione, shs, strong heart study, serca, sarcoplasmic/endoplasmic reticulum ca2+-atpase, nf-κb, nuclear factor κb, lvh, lv hypertrophy, vegf, vascular endothelial growth factor, ace, angiotensin-converting enzyme, at1, angii type 1 receptor, pkc, protein kinase c, hfnef, hf with a normal ef, klk, kallikrein, et, endothelin, mhc, myosin heavy chain, glut4, glucose transporter 4, tunel, terminal deoxynucleotidyl transferase-mediated dutp nick-end labelling, rv, right ventricular, parp, poly(adp-ribose) polymerase, nyha, new york heart association, ncx, na2+/ca2+ exchange, dpp-4, dipeptidyl peptidase-4, age, advanced glycosylation end-product, ryr, ryanodine receptor, sr, sarcoplasmic reticulum, erk, extracellular-signal-regulated kinase, kks, klk–kinin system, pmca, plasma-membrane ca2+-atpase, mi, myocardial infarction, lved, left ventricular end-diastole, b1r, b1-receptor, acei, ace inhibitor, bk, bradykinin, rr, relative risk, lv, left ventricular, ras, renin–angiotensin system, bp, blood pressure, chs, cardiovascular health study, hf, heart failure, dag, diacylglycerol, heart failure, bnp, brain natriuretic peptide, b2r, b2-receptor, hklk, human klk, ukpds, uk prospective diabetes study, mr, magnetic resonance, tdi, tissue doppler imaging, diabetic cardiomyopathy, glp-1, glucagon-like peptide-1, dgk, dag kinase, charm, candesartan in heart failure: assessment of reduction in mortality and morbidity, ros, reactive oxygen species, stz, streptozotocin, lvm, lv mass, tgf-β1, transforming growth factor-β1

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