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Keynote webinar | Spotlight on medication adherence

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Current Diabetes Reports
Published in: Current Diabetes Reports 3/2012

01-06-2012 | Management of Macrovascular Disease in Diabetes (S Inzucchi and R Goldberg, Section Editors)

Update on Diabetic Cardiomyopathy: Inches Forward, Miles to Go

Authors: Maggie N. Tillquist, Thomas M. Maddox

Published in: Current Diabetes Reports | Issue 3/2012

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Abstract

Diabetes causes cardiomyopathy, both directly and by potentiating the effect of its common comorbidities, coronary artery disease and hypertension, on its development. With the common and growing prevalence of diabetes worldwide, diabetic cardiomyopathy is a significant public health problem. Recent research identifies both mitochondrial dysfunction and epigenetic effects as newly recognized factors in the complex pathogenesis of diabetic cardiomyopathy. Diagnostically, specialized echocardiography techniques, cardiac magnetic resonance imaging, and serologic biomarkers all appear to have promise in detecting the early stages of diabetic cardiomyopathy. Research into treatments includes both traditional diabetes and heart failure therapies, but also explores the potential of newer metabolic and anti-inflammatory agents. These recent insights provide important additions to our knowledge about diabetic cardiomyopathy, but much remains unknown.
Literature
1.
Rubler S, Dlugash J, Yuceoglu YZ, et al. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol. 1972;30:595–602.PubMedCrossRef
2.
Aneja A, Tang W, Bansilal S, et al. Diabetic cardiomyopathy: insights into pathogenesis, diagnostic challenges, and therapeutic options. Am J Med. 2008;121(9):748–57.PubMedCrossRef
3.
Masoudi FA, Inzucchi SE. Diabetes mellitus and heart failure: epidemiology, mechanisms, and pharmacotherapy. Am J Cardiol. 2007;99(4):113–32.CrossRef
4.
Battiprolu P, Gillette T, Wang Z, Lavandero S, Hill J. Diabetic cardiomyopathy: mechanisms and therapeutic targets. Drug Discov Today Dis Mech. 2010;7(2):e135–43.PubMedCrossRef
5.
Fang ZY, Prins JB, Marwick TH. Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocr Rev. 2004;25(4):543–67.PubMedCrossRef
6.
Sasso FC, Rambaldi PF, Carbonara O, et al. Perspectives of nuclear diagnostic imaging in diabetic cardiomyopathy. Nutr Metab Cardiovasc Dis. 2010;20(3):208–16.PubMedCrossRef
7.
8.
Van Buren P, LeWinter M. Heart failure: a companion to Braunwald’s heart disease. Chapter 26—heart failure as a consequence of diabetic cardiomyopathy. Elsevier Inc. 2011. pp. 408–418.
9.
Shindler DM, Kostis JB, Yusuf S, et al. Diabetes Mellitus, a predictor of morbidity and mortality in the studies of the left ventricular dysfunction (SOLVD) trials and registry. Am J Cardiol. 1996;77:1017–20.PubMedCrossRef
10.
Ryden L, Armstrong PW, Cleland JG, et al. Efficacy and safety of high dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial. Eur Heart J. 2000;21:1967–78.PubMedCrossRef
11.
12.
•• Maisch B, Alter P, Pankuweit S. Diabetic cardiomyopathy – fact or fiction? Herz. 2011;36(2):102–15. This review provided a new, expanded classification of diabetic cardiomyopathy stages..PubMedCrossRef
13.
•• Singh G, Sharma R, Khullar M. Epigenetics and diabetic cardiomyopathy. Diabetes Res Clin Pract. 2011;94(1):14–21. This review outlined the role of epigenetic phenomena in diabetic cardiomyopathy.PubMedCrossRef
14.
Voulgari C, Papadoglannis D, Tentolouris N. Diabetic cardiomyopathy: from the pathophysiology of the cardiac myocytes to current diagnosis and management strategies. Vasc Health Risk Manag. 2010;6:883–903.PubMedCrossRef
15.
Mytas DZ, Stougiannos PN, Zairis MN, et al. Diabetic myocardial disease: pathophysiology, early diagnosis and therapeutic options. J Diabetes Complications. 2009;23(4):273–82.PubMedCrossRef
16.
Tarquini R, Lazzeri C, Pala L, Rotella CM, Gensini GF. The diabetic cardiomyopathy. Acta Diabetol. 2011;48(3):173–81.PubMedCrossRef
17.
Wenmeng W, Qizhu T. Early administration of trimetazidine may prevent or ameliorate diabetic cardiomyopathy. Med Hypotheses. 2011;76(2):181–3.PubMedCrossRef
18.
Rollm N, Ingul C, Hansen H, et al. Increased sensitivity to ischemia in an early diabetic cardiomyopathy: the role of calcium handling. Biophys J. 2009;96(3):119a.CrossRef
19.
Falcao-Pires I, Leite-Moreira AF. Diabetic cardiomyopathy: understanding the molecular and cellular basis to progression diagnosis and treatment. Heart Fail Rev. 2011; [Epub ahead of print].
20.
Flotats A, Carrio I. Is cardiac autonomic neuropathy the basis of non-ischemic diabetic cardiomyopathy? JACC: Cardiovasc Imag. 2010;3(12):1216–7.CrossRef
21.
Mustonen J, Mantysaari M, Kuikka J. Decreased myocardial 123I-metaiodobenzylguanidine uptake is associated with disturbed LV diastolic filling in diabetes. Am Heart J. 1992;123:804–5.PubMedCrossRef
22.
Bisognano JD, Weinberger HD, Bohimeyer TJ, et al. Myocardial-directed overexpression of the human B(1)-adrenergic receptor in transgenic mice. J Mol Cell Cardiol. 2000;32:817–30.PubMedCrossRef
23.
•• Duncan JG. Mitochondrial dysfunction in diabetic cardiomyopathy. Biochim Biophys Acta Mol Cell Res. 2011;1813(7):1351–9. This review outlined the role of mitochondrial dysfunction in the pathophysiology of diabetic cardiomyopathy.CrossRef
24.
Berg TJ, Snorgaard O, Faber J, et al. Serum levels of advanced glycation end products are associated with left ventricular diastolic function in patients with type 1 diabetes. Diabetes Care. 1999;22:118–1190.CrossRef
25.
Kajstura J, Fiordaliso F, Androli AM, et al. IGF-1 overexpression inhibits the development of diabetic cardiomyopathy and angiotensin II-medicated oxidative stress. Diabetes. 2001;50:1414–24.PubMedCrossRef
26.
•• From AM, Scott CG, Chen HH. The development of heart failure in patients with diabetes mellitus and preclinical diastolic dysfunction: a population-based study. JACC. 2010;55(4):300–5. This study investigated characteristics of diabetic patients with diastolic dysfunction from 2001–2007. It provides an original detailed analysis of subclinical diastolic dysfunction in this population.PubMed
27.
Maya L, Villarreal F. Diagnostic approaches for diabetic cardiomyopathy and myocardial fibrosis. J Mol Cell Cardiol. 2010;48(3):524–9.PubMedCrossRef
28.
Fang ZY, Schull-Meade R, Downey M, et al. Determinants of subclinical diabetic heart disease. Diabetologia. 2005;48:394–402.PubMedCrossRef
29.
•• Ernande L, Bergerot C, Rietzchel E, et al. Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy? J Am Soc Echocardiogr. 2011;24(11):1268–75. This paper challenged the previously held hypothesis that diastolic dysfunction is the first marker of diabetic cardiomyopathy, and argued that systolic strain alteration may precede diastolic dysfunction.PubMedCrossRef
30.
Ng AC, Delgado V, Bertini M, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol. 2009;104:1398–401.PubMedCrossRef
31.
Nakai H, Takeuchi M, Nishikage T, et al. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr. 2009;10:926–32.PubMedCrossRef
32.
Boyer JK, Thanigaraj S, Schechtman KB, Perez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive diabetic mellitus. Am J Cardiol. 2004;93:870–5.PubMedCrossRef
33.
Di Bonito P, Moio N, Cavuto L, et al. Early detection of diabetic cardiomyopathy: usefulness of tissue Doppler imaging. Diabet Med. 2005;22:1720–5.PubMedCrossRef
34.
Kim DH, Kim YJ, Kim HK, et al. Usefulness of mitral annulus velocity for the early detection of left ventricular dysfunction in a rat model of diabetic cardiomyopathy. J Cardiovasc Ultrasound. 2010;18(1):6–11.PubMedCrossRef
35.
Thrainsdottir I, Maimberg K, Olsson A, et al. Initial experience with GLP-1 treatment on metabolic control and myocardial function in patients with type 2 diabetes mellitus and heart failure. Diab Vasc Dis Res. 2004;1:40–3.PubMedCrossRef
36.
Rosen R, Rump AF, Rosen P. The ACE-inhibitor captopril improves myocardial perfusion in spontaneously diabetic (BB) rats. Diabetologia. 1995;38:509–17.PubMedCrossRef
37.
Rijzewijk LJ, van der Meer RW, Lamb HJ, de Jong HW, Lubberink M, Romijn JA, Bax JJ, de Roos A, Twisk JW, Heine RJ, Lammertsma AA, Smit JW, Diamant M. Altered myocardial substrate metabolism and decreased diastolic function in nonischemic human diabetic cardiomyopathy: studies with cardiac positron emission tomography and magnetic resonance imaging. J Am Coll Cardiol. 2009;54(16):1524–32.
38.
Epshteyn V, Morrison K, Krishnaswamy P, et al. Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes. Diabetes Care. 2003;26:2081–7.PubMedCrossRef
39.
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW; American College of Cardiology Foundation; American Heart Association. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. 2009;53(15):e1–e90.
40.
•• Romano S, Mauro M, Fratini S, et al. Early diagnosis of left ventricular diastolic dysfunction in diabetic patients: a possible role for natriuretic peptides. Cardiovasc Diabetol. 2010;9:89. This study established BNP as a screening tool for subclinical diabetic cardiomyopathy.PubMedCrossRef
41.
Mogelvang R, Goetze JP, Pedersen SA, et al. Preclinical systolic and diastolic dysfunction assessed by tissue Doppler imaging is associated with elevated plasma pro-B-type natriuretic peptide concentrations. J Card Fail. 2009;15:489–95.PubMedCrossRef
42.
Betti I, Castelli G, Barchielli A, et al. The role of N-terminal PRO-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study. J Card Fail. 2009;15:377–84.PubMedCrossRef
43.
Ihm S, et al. Serum carboxy-terminal propeptide of type 1 procollagen (PIP) is a marker of diastolic dysfunction in patients with early type 2 diabetes mellitus. Int J Cardiol 2007;e36–8.
44.
Martos R, Baugh J, Ledwidge M, et al. Diastolic heart failure: evidence of increased myocardial collagen turnover linked to diastolic dysfunction. Circulation. 2007;115:888–95.PubMedCrossRef
45.
Meier M, Hummel M. Cardiovascular disease and intensive glucose control in type 2 diabetes mellitus: moving practice toward evidence-based strategies. Vasc Health Risk Manag. 2009;5:859–71.PubMedCrossRef
46.
Von Bibra H, Hansen A, Dounis V, et al. Augmented metabolic control improves myocardial diastolic function and perfusion in patients with non-insulin dependent diabetes. Hear Vessel. 1994;9:121–8.CrossRef
47.
Von Bibra H, Siegmund T, Hansen A, et al. Augmentation of myocardial function by improved glycemic control in patients with type 2 diabetes mellitus. Dtsch Med Wochenschr. 2007;132:729–34.CrossRef
48.
Bibra H, Siegmund T, Ceriello A, et al. Optimized postprandial glucose control is associated with improved cardiac/vascular function—comparison of three insulin regimens in well-controlled type 2 diabetes. Horm Metab Res. 2009;41(2):109–15.PubMedCrossRef
49.
•• Hordern MD, Coombes JS, Cooney LM, et al. Effects of exercise intervention on myocardial function in type 2 diabetes. Heart. 2009;95(16):1343–9. This study failed to find an effect of exercise on diastolic dysfunction in diabetic patients.PubMedCrossRef
50.
Naka KK, Pappas K, Papathanassiuo K, et al. Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue Doppler imaging study. Cardiovasc Diabetol. 2010;23:9–57.
51.
Hare JL, Horder MD, Leano R, et al. Application of an exercise intervention on the evolution of diastolic dysfunction in patients with diabetes mellitus: efficacy and effectiveness. Circ Heart Fail. 2011;4(4):441–9.PubMedCrossRef
52.
•• ADVANCE Echocardiography Substudy Investigators, ADVANCE Collaborative Group. Effects of perinopril-indapamide on left ventricular diastolic function and mass in patients with type 2 diabetes: the ADVANCE Echocardiography Substudy. J Hypertens. 2011;29(7):1439–47. This study failed to find an effect of a combination ACEI/diuretic on diastolic dysfunction among diabetic patients.
53.
Rajesh M, Mukhopadyay P, Batkai S, et al. Cannabidiol attenuates cardiac dysfunction, oxidative stress, fibrosis, and inflammatory and cell death signaling pathways in diabetic cardiomyopathy. J Am Coll Cardiol. 2010;56(25):2115–25.PubMedCrossRef
Metadata
Title
Update on Diabetic Cardiomyopathy: Inches Forward, Miles to Go
Authors
Maggie N. Tillquist
Thomas M. Maddox
Publication date
01-06-2012
Publisher
Current Science Inc.
Published in
Current Diabetes Reports / Issue 3/2012
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-012-0274-7

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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