The Heart in Diabetes in Early and Advanced Nephropathy

  • Ole Gøtzsche
  • Leif Thuesen
  • Helle Dybdahl
Part of the Topics in Renal Medicine book series (TIRM, volume 6)


Few studies have systematically analyzed concomitant changes in the heart and kidney in diabetes mellitus. Structural similarities, such as capillary basement membrane thickening, microaneurysms, periodic and acid—Schiff (PAS)-positive deposits in the vessel walls, do suggest that diabetic angiopathy is present in both organs. However, it must be stressed that, apart from being influenced by the metabolic abnormalities in diabetes per se, cardiac functions are influenced by the consequences of diabetic renal disease such as anemia, hypoproteinemia, electrolyte disturbances, and hypertension. The factors can, separately or in combination, lead to functional and structural changes in the heart. Moreover, the progression of diabetic nephropathy and diabetic cardiopathy seems to accelerate in the presence of hypertension [1, 2].


Diabetic Patient Diabetic Nephropathy Diabetic Cardiomyopathy Significant Coronary Artery Disease Cold Pressor Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Factor SM, Minase T, Sonnenblick EH: Clinical and morphological features of human hypertensive diabetic cardiopathy. Am Heart J 99: 446–458, 1980.PubMedCrossRefGoogle Scholar
  2. 2.
    Mogensen CE, Christensen CK: Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 311: 89–93, 1984.PubMedCrossRefGoogle Scholar
  3. 3.
    Dash H, Johnson RA, Dinsmore RE, Franics CK, Harthorne JW: Cardiomyopathie syndrome due to coronary artery disease: increased prevalence in patients with diabetes mellitus—matched pair analysis. Br Heart J 39: 740–747, 1977.PubMedCrossRefGoogle Scholar
  4. 4.
    Regan TJ, Lyons MM, Ahmed SS, Levinson GE, Oldewurtel HA, Ahmad MR, Haider B: Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest 60: 885–899, 1977.CrossRefGoogle Scholar
  5. 5.
    Bennett WM, Kloster F, Rosch J, Barry J, Porter GA: Natural history of asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal disease. Am J Med 65: 779–784, 1978.PubMedCrossRefGoogle Scholar
  6. 6.
    Braun WE, Phillips DF, Vidt DG, Novick AC, Nakamoto S, Popowniak KL, Paganini E, Magnusson M, Pohl M, Steinmuller DR, Protiva D, Buszta C: Coronary artery disease in 100 diabetics with end stage renal failure. Transplant Proc 16: 603–607, 1984.PubMedGoogle Scholar
  7. 7.
    Weinrauch L, D’Elia JA, Healy RW, Gleason RE, Christlieb AR, Leland OS: Asymptomatic coronary disease: angiographie assessment of diabetics evaluated for renal transplantation. Circulation 58: 1184–1190, 1978.PubMedCrossRefGoogle Scholar
  8. 8.
    D’elia JA, Weinrauch LA, Healy RW, Libertino JA, Bradley RF, Leland OS: Myocardial dysfunction without coronary artery disease in diabetic renal failure. Am J Cardiol 43: 193–199, 1979.PubMedCrossRefGoogle Scholar
  9. 9.
    Weinrauch LA, D’Elia JA, Healy RW, Gleason RE, Takacs FJ, Libertino JA, Leland OS: Asymptomatic coronary artery disease: angiography in diabetic patients before renal transplantation. Ann Intern Med 88: 346–348, 1978.PubMedGoogle Scholar
  10. 10.
    Seneviratne BIB: Diabetic cardiomyopathy: the preclinical phase. Br Med J 1: 1444–1446, 1977.PubMedCrossRefGoogle Scholar
  11. 11.
    Shapiro LM, Leatherdale BA, Mackinnon J, Fletcher RF: Left ventricular function in diabetes mellitus. H. Relation between clinical features and left ventricular function. Br Heart J 45: 129–132, 1981.PubMedCrossRefGoogle Scholar
  12. 12.
    Jermendy G, Kammerer ZM, Koltai, et al.: Preclinical abnormality of left ventricular performance in patients with insulin dependent diabetes mellitus. Acta Diabetol Lat 20: 311–320, 1982.CrossRefGoogle Scholar
  13. 13.
    Ahmed SS, Jaferi GA, Narang RM, Regan TJ: Preclinical abnormality of left ventricular function in diabetes mellitus. Am Heart J 89: 153–158, 1975.PubMedCrossRefGoogle Scholar
  14. 14.
    Friedman NE, Levitsky LL, Edidin DV, Vitullo DA, Lacina SJ, Cheimmongkoltip P: Echo-cardiographic evidence for impaired myocardial performance in children with type 1 diabetes mellitus. Am J Med 73: 846–850, 1982.PubMedCrossRefGoogle Scholar
  15. 15.
    Pillsbury HC, Hung W, Kyle MC, Freis ED: Arterial pulse waves and velocity and systolic time intervals in diabetic children. Am Heart J 87: 783–790, 1974.PubMedCrossRefGoogle Scholar
  16. 16.
    Shapiro LM, Howat AP, Calter MM: Left ventricular function in diabetes mellitus. 1. Methodology, and prevalence and spectrum of abnormalities. Br Heart J 45: 122–128, 1981.PubMedCrossRefGoogle Scholar
  17. 17.
    Uusitupa M, Siitonen O, Aro A, Korhonen R, Pyrorala I: Effect of correction of hyperglycemia on left ventricular function in non-insulin dependent (type 2) diabetics. Acta Med Scand 213: 363–368, 1983.PubMedCrossRefGoogle Scholar
  18. 18.
    Shapiro LM, Leatherdale BA, Coyne ME, Fletcher RF, Makinnon J: Prospective study of heart disease in untreated maturity onset diabetics. Br Heart J 44: 342–348, 1980.PubMedCrossRefGoogle Scholar
  19. 19.
    Sanderson JE, Brown DJ, Rivellese A, Kohner E: Diabetic cardiomyopathy? An echocardiographic study of young diabetics. Br Med J 1: 404–407, 1978.PubMedCrossRefGoogle Scholar
  20. 20.
    Shapiro LM: A prospective study of heart disease in diabetes mellitus. Q J Med 53: 55–68, 1984.PubMedGoogle Scholar
  21. 21.
    Thuesen L, Christiansen JS, Falstie-Jensen N, Christensen CK, Hermansen K, Mogensen CE, Henningsen P: Increased myocardial contractility in short-term type 1 diabetic patients: an echocardiographic study. Diabetologia 28: 822–826, 1985.PubMedCrossRefGoogle Scholar
  22. 22.
    Gotzsche O, Sorensen K, McIntyre B: Increased contractility and reduced afterload of the left ventricle in children with insulin dependent diabetes mellitus: a Doppler-echocardiographic evaluation of left ventricular systolic and diastolic function. Br Heart J (in press), 1987.Google Scholar
  23. 23.
    Goldweit RS, Borer JS, Jovanovic LG, Drexler AJ, Hochreiter CA, Devereux RB, Peterson CM: Relation of hemoglobin Al and blood glucose to cardiac function in diabetes mellitus. Am J Cardiol 56: 642–646, 1985.PubMedCrossRefGoogle Scholar
  24. 24.
    Mathiesen ER, Hilsted J, Feldt-Rasmussen B, Bonde-Petersen F, Christensen NJ, Parving HH: Effect on matabolic control on hemodynamics in short-term insulin dependent diabetic patients. Diabetes 34: 1301–1305, 1985.PubMedCrossRefGoogle Scholar
  25. 25.
    Dandona P, Wollard ML, James IM, Newburry P, Beckett AG: Instability of cerebral blood flow in insulin-dependent diabetics. Lancet 2: 1203–1205, 1979.PubMedCrossRefGoogle Scholar
  26. 26.
    Kohner EM, Hamilton AM, Saunders SJ, Suttcliff BA, Bulpitt CJ: The retinal blood flow and diabetes. Diabetologia 11: 27–33, 1975.PubMedCrossRefGoogle Scholar
  27. 27.
    Gundersen HJG: Peripheral blood-flow and metabolic control in juvenile diabetes. Diabetologia 10: 225–231, 1974.PubMedCrossRefGoogle Scholar
  28. 28.
    Christiansen JS, Gammelgaard J, Tronier B, Svendsen PAa, Parving H-H: Kidney function and size in diabetics before and during initial insulin treatment. Kidney Int 21: 683–688, 1982.PubMedCrossRefGoogle Scholar
  29. 29.
    Carlström C, Karlefors T: Haemodynamic studies on newly diagnosed diabetics before and after adequate insulin treatment. Br Heart J 32: 355–358, 1970.PubMedCrossRefGoogle Scholar
  30. 30.
    Abenavoli T, Tubler S, Fisher JV, Axelrod HE, Zuckerman KP: Exercise testing with myocardial scintigraphy in asymptomatic diabetic males. Circulation 63: 54–64, 1981.PubMedCrossRefGoogle Scholar
  31. 31.
    Vered Z, Battler A, Segal P, Liberman D, Yerushalmi Y, Berezin M, Neufeld HN: Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol 54: 633–637, 1984.PubMedCrossRefGoogle Scholar
  32. 32.
    Friedman HS, Sacerdote A, Bandu I, Jubay F, Herrera AG, Vasavava BC, Bleicher SJ: Abnormalities of the cardiovascular response to cold pressor test in type 1 diabetes: correlation with blood glucose control. Arch Intern Med 144: 43–47, 1984.PubMedCrossRefGoogle Scholar
  33. 33.
    Harrower ADB, Railton R, Newman P: Relationship of diabetic control to left ventricular ejection fraction during cold stimulation tests in type 1 (insulin dependent) diabetes [abstr 160]. Diabetologia 25: 162, 1983.Google Scholar
  34. 34.
    Fischer VW, Barner HB,.Leskiw ML: Capillary basal laminar thickness in diabetic human myocardium. Diabetes 28: 713–719, 1979.PubMedCrossRefGoogle Scholar
  35. 35.
    Fischer VW, Barner HB, Larose LS: Pathomorphological aspects of muscular tissue in diabetes mellitus. Hum Pathol 15: 1127–1136, 1984.PubMedCrossRefGoogle Scholar
  36. 36.
    Fischer VW, Leskiw ML, Barner HB: Myocardial structure and capillary basal laminar thickness in experimentally diabetic rats. Exp Mol Pathol 35: 344–356, 1981.CrossRefGoogle Scholar
  37. 37.
    Factor SM, Okun EM, Minase T: Capillary microaneurysm in the human diabetic heart. N Engl J Med 302: 384–388, 1980.PubMedCrossRefGoogle Scholar
  38. 38.
    Blumenthal HT, Alex M, Goldberg S: A study of lesions of the intramural coronary branches in diabetes mellitus. Arch Pathol 70: 13–28, 1960.Google Scholar
  39. 39.
    Zoneraich S, Silverman G: Myocardial small vessel disease in diabetic patients. In: Zoneraich S (ed) Diabetes and the heart. Springfield IL: CC Thomas, 1978, pp 3–18.Google Scholar
  40. 40.
    Ledet T: Histological and histochemical changes in the coronary arteries of old diabetic patients. Diabetologia 4: 268–272, 1968.PubMedCrossRefGoogle Scholar
  41. 41.
    Ledet T: Diabetic cardiopathy: quantitative histological studies of the heart from young juvenile diabetics. Acta Pathol Microbiol Scand [A184: 421–428, 1976.Google Scholar
  42. 42.
    Baandrup U, Ledet T, Rasch R: Experimental diabetic cardiopathy preventable by insulin treatment. Lab Invest 45: 169–173, 1981.PubMedGoogle Scholar
  43. 43.
    Bell ET: A postmortem study of vascular disease indiabetics. Arch Pathol 53: 444–455, 1952.Google Scholar
  44. 44.
    Vigorita VJ, Moore GW, Hutchin GM: Absence of correlation between coronary arterial atherosclerosis and severity or duration of diabetes mellitus of adult onset. Am J Cardiol 46: 535–542, 1980.PubMedCrossRefGoogle Scholar
  45. 45.
    Crall FV, Roberts WC: The extramural and intramural coronary arteries in juvenile diabetes mellitus. Am J Med 64: 221–230, 1978.PubMedCrossRefGoogle Scholar
  46. 46.
    Ferrier TM: Radiologically demonstrable arterial calcification in diabetes mellitus. Aust Ann Med 13:222–228, 1964Google Scholar
  47. 47.
    Neubauer B, Gundersen HJG: Calcifications, narrowing and rugosities of the leg arteries in diabetic patients. Acta Radio] 24: 401–413, 1983.Google Scholar
  48. 48.
    Dybdahl H, Ledet T: Diabetic macroangiopathy: quantitative histopathological studies of the extramural coronary arteries from type II diabetic subjects Iabstr 1311 Diabetologia 29: 534A, 1986.Google Scholar
  49. 49.
    Regan TJ, Ahmed SS, Levinson GE, Oldewurtel HA, Ahmad MR, Haider B, Lyons MM: Cardiomyopathy and regional scar in diabetes mellitus. Trans Assoc Am Phys 85: 217–223, 1975.Google Scholar
  50. 50.
    Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A: New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30: 595–602, 1972.PubMedCrossRefGoogle Scholar
  51. 51.
    Fein FS, Korsstein LB, Strobeck JE, Capasso JM, Sonnenblick EH: Altered myocardial mechanics in diabetic rats. Cire Res 47: 922–933, 1980.CrossRefGoogle Scholar
  52. 52.
    Fein FS, Strobeck JE, Malhotra A, Scheuer J, Sonnenblick EH: Reversibility of diabetic cardiomyopathy with insulin in rats. Cire Res 49: 1251–1261, 1981.CrossRefGoogle Scholar
  53. 53.
    Penpargkul S, Fein FS, Sonnenblick EH, Scheuer J: Depressed cardiac sarcoplasmic reticular function from diabetic rats. J Mol Cell Cardiol 13: 303–309, 1981.PubMedCrossRefGoogle Scholar
  54. 54.
    Pierce GN, Kutryk MJB, Dhalla NSD: Alterations in Cat+ binding by and composition of the cardiac sarcolemmal membrane in chronic diabetes. Proc Natl Acad Sci USA 80: 54125416, 1983.Google Scholar
  55. 55.
    Getzsche O: Abnormal myocardial calcium uptake in streptozotocin diabetic rats: evidence for a direct insulin effect on catecholamine sensitivity. Diabetes 34: 287–290, 1985.CrossRefGoogle Scholar
  56. 56.
    Getzsche O: Myocardial cell dysfunction in diabetes mellitus: a review of clinical and experimental studies. Diabetes 35: 1158–1162, 1986.CrossRefGoogle Scholar
  57. 57.
    Getzsche O: The adrenergic 1-receptor adenylate cyclase system in heart and lymphocytes from streptozotocin-diabetic rats: in vivo and in vitro evidence for a desensitized myocardial 13-receptor. Diabetes 32: 1110–1116, 1983.CrossRefGoogle Scholar
  58. 58.
    Dillmann WH: Diabetes mellitus induces changes in cardiac myosin of the rat. Diabetes 29: 579–582, 1980.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1988

Authors and Affiliations

  • Ole Gøtzsche
  • Leif Thuesen
  • Helle Dybdahl

There are no affiliations available

Personalised recommendations