Bala Cornelia, Hâncu N
Clinical Center of Diabetes, Nutrition, Metabolic Disease, Cluj-Napoca, Romania.
Rom J Intern Med. 2004;42(2):267-75.
Diabetes substantially increases the risk of heart failure both in men and women, being included in the Stage A classification of heart failure by the American Societies of Cardiology. The main etiological factors contributing to heart failure in diabetes are coronary artery disease, systemic hypertension and diabetic cardiomyopathy, the latter being invoked in case of heart failure where the first two factors are missing. Renal insufficiency and obesity may also play a role. The diagnosis will follow the same steps as in non-diabetic subjects: careful and periodic assessment for signs and symptoms of heart failure in all diabetic patients, echocardiography to assess the systolic and diastolic function of the left ventricle, and B-type natriuretic peptide level (as a marker of left ventricular dysfunction). The therapeutic approach will include non-pharmacological measures and pharmacological treatment. Patients with diabetes and heart failure benefit of the same drugs as non-diabetic subjects, including beta-blockers, which should not be avoided in patients with diabetes. The antihyperglycemic agents that should not be used in patients with heart failure are biguanides and thiazolidindiones (pioglitazone can be used in NYHA I and II classes). Approaches that were proven to reduce the risk of heart failure in diabetes are blood pressure and lipid control, treatment with ACE inhibitors in patients with diabetes and other cardiovascular risk factors and improvement of the glycemic control.
糖尿病显著增加男性和女性心力衰竭的风险，美国心脏病学会将其列入心力衰竭A期分类。导致糖尿病患者心力衰竭的主要病因包括冠状动脉疾病、系统性高血压和糖尿病性心肌病，若不存在前两个因素，则会考虑后者导致的心力衰竭。肾功能不全和肥胖也可能起作用。诊断步骤与非糖尿病患者相同：对所有糖尿病患者进行仔细且定期的心力衰竭体征和症状评估，通过超声心动图评估左心室的收缩和舒张功能，以及检测B型利钠肽水平（作为左心室功能障碍的标志物）。治疗方法将包括非药物措施和药物治疗。糖尿病合并心力衰竭患者与非糖尿病患者使用相同的药物，包括β受体阻滞剂，糖尿病患者不应避免使用。心力衰竭患者不应使用的降糖药物是双胍类和噻唑烷二酮类（吡格列酮可用于纽约心脏协会心功能I级和II级患者）。已被证明可降低糖尿病患者心力衰竭风险的方法包括控制血压和血脂、对有糖尿病和其他心血管危险因素的患者使用血管紧张素转换酶抑制剂治疗以及改善血糖控制。
