MAKING THE CALL:EARLY RECOGNITION OF HEART FAILURE IN TYPE 2 DIABETES (T2D)
It’s important to be mindful that all of the major risk factors for heart failure (HF) may already be present in patients with type 2 diabetes mellitus.1 In fact, many of the symptoms are non-specific, and by themselves, do not discriminate between HF and other disorders.2
IN PATIENTS WITH T2D, THERE IS RESIDUAL HF RISK DESPITE OPTIMAL CONTROL OF CV RISK FACTORS3
Some examples of common risk factors and comorbidities include3*:
Elevated Glycated hemoglobin level
Elevated LDL cholesterol level
Despite controlling these cardiovascular risk factors, patients with T2D still had a 45%
greater risk of developing heart failure compared to patients without T2D3†
EARLY SIGNS AND SYMPTOMS OF HEART FAILURE CAN BE DIFFICULT TO RECOGNIZE.
Be sure to look for these symptoms and signs of HF2,4,5:
Fatigue and Exercise Intolerance
Breathing at Night
Loss of Appetite
(Sudden weight gain 2-3 lbs in 24 hours)5
Swelling in Feet
TWO SUB-TYPES OF HEART FAILURE
Patients with HF experience decreased cardiac output.1,2
In diastolic HF, the heart cannot fill with enough blood—also referred to as HF with preserved ejection fraction (HFpEF).1,2
In systolic HF, the heart has a reduced ability to pump or eject blood—also referred to as HF with reduced ejection fraction (HFrEF).1,2
References: 1. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;62(16):e147-e239. 2. Bloom MW, Greenberg B, Jaarsma T, et al. Heart failure with reduced ejection fraction. Nat Rev Dis Primers. 2017;3:17058.
NT-proBNP ASSAYS CAN HELP YOU STRATIFY YOUR AT-RISK PATIENTS AND FACILITATE CLINICAL DECISION MAKING
NT-proBNP is a cardiac biomarker that can help diagnose heart failure, assess risk, and inform decision-making.
The test targets the N-terminal pro-B-type natriuretic peptides (NT-proBNP) biomarker.
Elevated serum levels of NT-proBNP may indicate heart failure; levels tend to increase with disease severity.
LEARN MORE ABOUT NT-proBNP AND HEART FAILURE
*Cutoff values were as follows: glycated hemoglobin level (≥7.0%), systolic blood pressure (≥140 mm Hg), diastolic blood pressure (≥80 mm Hg), and LDL cholesterol level (≥97 mg/dL). Criteria for albuminuria were the presence of microalbuminuria or macroalbuminuria, and smoking was defined as being a current smoker at study entry.3
†Based on a cohort study including 271,174 patients with T2D registered in the Swedish National Diabetes Register, matched to 1,355,870 controls according to age, sex, and county. Risk factors included A1C level (≥7.0%), systolic (≥140 mm Hg) and diastolic (≥80 mm Hg) blood pressure, LDL-C (≥97 mg/dL), albuminuria, and tobacco use.3
1.Thomas MC. Type 2 diabetes and heart failure: challenges and solutions. Curr Cardiol Rev. 2016;12(3):249-255. 2. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129-2200. 3. Rawshani A, Rawshani A, Franzén S, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2018;379(7):633-634. 4. National Heart, Lung, and BIood Institute. Heart failure. https://www.nhlbi.nih.gov/health-topics/heart-failure. Accessed December 17, 2019. 5. American Heart Association. Self-check plan for HF management. https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure. Accessed December 17, 2019.
VIDEO: IDENTIFYING HEART FAILURE IN TYPE 2 DIABETES (T2D)
Clinicians who treat patients with type 2 diabetes generally strive for optimal glycemic control. But these patients are also at risk for cardiovascular complications such as heart failure.
In this video, Dr. Javed Butler, Professor and Chairman of the Department of Medicine at the University of Mississippi Medical Center, delves into this important topic. Dr. Butler highlights factors that increase the risk of heart failure in patients with type 2 diabetes, how it may be recognized, and what we all can do moving forward.