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"Type 2 Diabetes Mellitus and Heart Failure: Implications for the Use of TZDs"Dr. Richard W. Nesto (biography)
English - 2004-06-04 - 68 minutes
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Summary :
Diabetes increases the risk of congestive heart failure, and this effect is more prominent in women (1). Diabetes has been found to exert effects on cardiac structure and function including increased left ventricular (LV) mass (2). Furthermore, the Framingham Heart Study showed that women had greater LV mass than men across the range of glucose tolerance, and insulin resistance was associated with increased LV mass in women alone (3).
Dr. Nesto discusses factors affecting LV remodeling post-MI in diabetes; new data on admission blood glucose level as a risk indicator for death after myocardial infarction (4); and the cardioprotective effects of agents such as insulin (5,6) and thiazolidinediones (7,8).
The Framingham study also found that individuals with asymptomatic LV systolic dysfunction were at higher risk for congestive heart failure (CHF) and death (9), and so it is of interest to know how to treat patients with asymptomatic heart disease. Dr. Nesto addresses recent reports on TZD use and CHF in people with type 2 diabetes, and outlines guidelines for the use of TZDs in patients with diabetes mellitus and coronary heart disease, both asymptomatic and symptomatic (10,11).
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Sex related differences in the risk of CHF in diabetes
- Diabetes-related changes in cardiac structure and function
- Recommendations for the use of TZDs in patients with diabetes mellitus and CHD
Bibliographic references :
1. D. Levy, M. G. Larson, R. S. Vasan, W. B. Kannel and K. K. Ho
The progression from hypertension to congestive heart failureJAMA. 1996;275(20):1557.
2. Richard B. Devereux, MD; Mary J. Roman, MD; Mary Paranicas, BA; Michael J. O’Grady, BA; Elisa T. Lee, PhD; Thomas K. Welty, MD, MPH; Richard R. Fabsitz, MA; David Robbins, MD; Everett R. Rhoades, MD; Barbara V. Howard, PhD Impact of Diabetes on Cardiac Structure and Function: The Strong Heart Study Circulation. 2000;101:2271.
3. Martin K. Rutter, MB, ChB; Helen Parise, ScD; Emelia J. Benjamin, MD, ScM; Daniel Levy, MD; Martin G. Larson, ScD; James B. Meigs, MD, MPH; Richard W. Nesto, MD; Peter W.F. Wilson, MD; Ramachandran S. Vasan, MD Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function: Sex-Related Differences in the Framingham Heart Study Circulation. 2003;107:448.
4. Ischa Stranders, MD; Michaela Diamant, MD, PhD; Rogier E. van Gelder, MD; Hugo J. Spruijt, MSEE; Jos W. R. Twisk, PhD; Robert J. Heine, MD, PhD, FRCP; Frans C. Visser, MD, PhD.Admission Blood Glucose Level as Risk Indicator of Death After Myocardial Infarction in Patients With and Without Diabetes Mellitus Arch Intern Med. 2004;164:982-988.
5. Michael N. Sack MD, PhD and Derek M. Yellon PhD, DSc, Hon FRCP, FACC.Insulin therapy as an adjunct toreperfusion after acute coronary ischemia: A proposed direct myocardial cell survival effect independent of metabolic modulation Journal of the American College of Cardiology. Volume 41, Issue 8 , 16 April 2003, Pages 1404-1407.
6. Dandona P, Aljada A, Mohanty P. "The anti-inflammatory and potential anti-atherogenic effect of insulin: a new paradigm." Diabetologia. 2002 Jun;45(6):924-30.
7. Tetsuya Shiomi, MD; Hiroyuki Tsutsui, MD; Shunji Hayashidani, MD; Nobuhiro Suematsu, MD; Masaki Ikeuchi, MD; Jing Wen, MD; Minako Ishibashi, MD; Toru Kubota, MD; Kensuke Egashira, MD; Akira Takeshita, MD Pioglitazone, a Peroxisome Proliferator–Activated Receptor-(gamma) Agonist, Attenuates Left Ventricular Remodeling and Failure After Experimental Myocardial Infarction Circulation. 2002;106:3126.
8. Tian-li Yue, PhD; Jun Chen, MS; Weike Bao, MD; Padma K. Narayanan, PhD; Antoine Bril, PhD; Wen Jiang, MD; Paul G. Lysko, PhD; Juan-Li Gu, MD; Rogely Boyce, PhD; Dawn M. Zimmerman, MS; Timothy K. Hart, PhD; Robin E. Buckingham, PhD; Eliot H. Ohlstein, PhD In Vivo Myocardial Protection From Ischemia/Reperfusion Injury by the Peroxisome Proliferator–Activated Receptor-(gamma) Agonist Rosiglitazone Circulation. 2001;104:2588.
9. Thomas J. Wang, MD; Jane C. Evans, DSc; Emelia J. Benjamin, MD, ScM; Daniel Levy, MD; Elizabeth C. LeRoy, BS; Ramachandran S. Vasan, MD Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community Circulation. 2003;108:977.
10. Richard W. Nesto, MD; David Bell, MD; Robert O. Bonow, MD; Vivian Fonseca, MD; Scott M. Grundy, MD, PhD; Edward S. Horton, MD; Martin Le Winter, MD; Daniel Porte, MD; Clay F. Semenkovich, MD; Sidney Smith, MD; Lawrence H. Young, MD; Richard Kahn, PhD Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure: A Consensus Statement From the American Heart Association and American Diabetes Association Circulation. 2003;108:2941.
11. Richard W. Nesto, MD, David Bell, MD, Robert O. Bonow, MD, Vivian Fonseca, MD, Scott M. Grundy, MD, PHD, Edward S. Horton, MD, Martin Le Winter, MD, Daniel Porte, MD, Clay F. Semenkovich, MD, Sidney Smith, MD, Lawrence H. Young, MD and Richard Kahn, PHD Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure: A consensus statement from the American Heart Association and American Diabetes Association Diabetes Care 27:256-263, 2004.
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