Diabetes mellitus and congestive heart failure

Diabetes mellitus, and in particular the type 2, has progressively become more common. Factors increasing the prevalence include an ageing population, an increasing body mass and decreased demands of physical activity. In type 2 diabetes manifestations of atherosclerosis are frequently present at the time of diagnosis. Approximately 20% of patients admitted to Swedish coronary care units for myocardial infarction have diabetes. In a recent health survey, 22% of diabetic patients reported that they needed to see a cardiologist during the previous 12 months and up to 50% had cardiovascular disease. As type 2 diabetes, including the pre-diabetic period, is an important risk factor for atherosclerosis the increasing prevalence suggests that there will be a considerable increase in diabetes-related cardiovascular disease in the near future. Ischaemic heart disease is still the leading cause of congestive heart failure despite advances in its prevention and treatment. Heart failure has increased in prevalence while there has been a decrease in the age-adjusted morbidity and mortality of coronary artery disease. An ageing population and increased survival of patients with myocardial infarction are likely explanations. Thus, diabetes mellitus is closely linked to congestive heart failure. Proper treatment, including meticulous metabolic control of the diabetes, may considerably improve the prognosis for diabetic patients with myocardial infarction and also possibly prevent its occurrence. Nevertheless, even with the best preventive strategies and expert treatment of established cardiovascular disease, a considerable proportion of heart failure patients will have diabetes. Further research is needed for the proper handling of these subjects. This may contribute not only to patient relief but also to a decrease of future demands on health care resources.