Heart Failure, Atrial Fibrillation, and Diabetes Mellitus

  • A. Aleksova
  • A. Perkan
  • G. Sinagra
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Diabetes mellitus is a common disease. The worldwide prevalence of diabetes- especially of the predominant type 2 diabetes mellitus which accounts for about 90% of the adult diabetic population-has increased rapidly and continuously during the last several decades. This phenomenon is a direct consequence of negative lifestyle changes in the population, including a reduction of physical activity and the availability of energydense food rich in saturated fat, leading to an increased prevalence of obesity. The global prevalence of diabetes mellitus in adults is predicted to increase to 5.4% in the year 2025 [1].


Atrial Fibrillation Chronic Heart Failure Brain Natriuretic Peptide United Kingdom Prospective Diabetes Study Hypertension Optimal Treatment 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    King H, Aubert RE, Herman WH (1998) Global burden of diabetes 1995–2025. Prevalence, numerical estimates and projections. Diabetes Care 21:1414–31PubMedCrossRefGoogle Scholar
  2. 2.
    Rydén L, Malmberg K (2000) Reducing the impact of diabetic heart’s increased vulnerability to cardiovascular disease. Dialogues Cardiovasc Med 5:5–22Google Scholar
  3. 3.
    Kannel WB, McGee DL (1979) Diabetes and cardiovascular disease. JAMA 241:2035–8PubMedCrossRefGoogle Scholar
  4. 4.
    Clark CM, Perry RC (1999) Type 2 diabetes and macrovascular disease. Epidemiology and etiology. Am Heart J 138:330–3CrossRefGoogle Scholar
  5. 5.
    Amato L, Paolisso G, Cacciatore F et al, on behalf of the Osservatorio Geriatrico Regione Campania Group (1997) Congestive heart failure predicts the development of non-insulin dependent diabetes mellitus in the elderly. Diabetes Metab 23:213–8PubMedGoogle Scholar
  6. 6.
    Furberg CD, Psaty BM, Manolio TA et al (1994) Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol 74:236–41PubMedCrossRefGoogle Scholar
  7. 7.
    Stratton IM, Adler AJ, Neil HA et al (2000) Association of glycemia with macrovascular and microvascular complicatons of type 2 diabetes (UKPDS 35). BMJ 321:405–12PubMedCrossRefGoogle Scholar
  8. 8.
    Maggioni AP, Latini R, Carson PE et al (2005) Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J 149:548–57PubMedCrossRefGoogle Scholar
  9. 9.
    Vermes E, Tardif JC, Bourassa MG et al (2003) Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction. Insight from the Studies Of Left Ventricular Dysfunction (SOLVD) Trials. Circulation 107:2926–31PubMedCrossRefGoogle Scholar
  10. 10.
    Poole-Wilson PA, Swedberg K, Cleland JGF et al (2003) Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet 362:7–13PubMedCrossRefGoogle Scholar
  11. 11.
    Young JB, Dunlap ME, Pfeffer MA et al (2004) Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM Low-Left Ventricular Ejection Fraction Trials. Circulation 110:2618–26PubMedCrossRefGoogle Scholar
  12. 12.
    The CONSENSUS Trial Study Group (1987) Effect of enalapril on mortality in severe congestive heart failure. N Engl J Med 316:1429–35CrossRefGoogle Scholar
  13. 13.
    Bode F, Katchman A, Woosley RL et al (2000) Gadolinium decreases stretch-induced vulnerability to atrial fibrillation. Circulation 101: 2200–5PubMedGoogle Scholar
  14. 14.
    Shinagawa K, Shi YF, Tardif JC et al (2002) Dynamic nature of atrial fibrillation substrate during development and reversal of heart failure in dogs. Circulation 105:2672–8PubMedCrossRefGoogle Scholar
  15. 15.
    Tsang TS, Gersh BJ, Appleton CP et al (2002) Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 40:1636–44PubMedCrossRefGoogle Scholar
  16. 16.
    Li D, Fareh S, Leung TK et al (1999) Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation 100:87–95PubMedGoogle Scholar
  17. 17.
    Cha YM, Dzeja PP, Shen WK et al (2003) Failing atrial myocardium: energetic deficits accompany structural remodeling and electrical instability. Am J Physiol Heart Circ Physiol 284:H1313–H1320PubMedGoogle Scholar
  18. 18.
    Wood D, De Backer G, Faergeman O et al (1998) Prevention of coronary heart disease in clinical practice. Summary of recommendations of the Second Joint Task Force of European and other Societies on Coronary prevention. Eur Heart J 19:1434–1503CrossRefGoogle Scholar
  19. 19.
    Swedberg K, Olsson L, Charlesworth A et al (2005) Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J 26:1303–8PubMedCrossRefGoogle Scholar
  20. 20.
    Bergstrom A, Andersson B, Edner M et al (2001) Carvedilol improves diastolic function in patients with diastolic heart failure [Abstract 3388]. Circulation 104(Suppl 2):718Google Scholar
  21. 21.
    Remme WJ, Riegger G, Hildebrandt P et al (2004) The benefits of early combination treatment of carvedilol and an ACE-inhibitor in mild heart failure and left ventricular systolic dysfunction. The carvedilol and ACE-inhibitor remodelling mild heart failure evaluation trial (CARMEN). Cardiovasc Drugs Ther 18:57–66PubMedCrossRefGoogle Scholar
  22. 22.
    Mihm MJ, Yu F, Carnes CA et al (2001) Impared myofibrillar energetics and oxydative injury during human atrial fibrillation. Circulation 104:174PubMedGoogle Scholar
  23. 23.
    Giugliano D, Acampora R, Marfella R et al (1997) Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin dependent diabetes mellitus and hypertension: a randomised, control trial. Ann Intern Med 126:955PubMedGoogle Scholar
  24. 24.
    Ohtsuka T, Hamada M, Saeki H et al (2002) Comparison of effects of carvedilol versus metoprolol on cytokine levels in patients with idopathic dilated cardiomyopathy. Am J Cardiol 89:996PubMedCrossRefGoogle Scholar
  25. 25.
    Aviles RJ, Martin DO, Apperson-Hansen C et al (2003) Inflammation as a risk factor for atrial fibrillation. Circulation 108:3006–10PubMedCrossRefGoogle Scholar
  26. 26.
    McGuire DK, Granger CB et al (1999) Diabetes and ischemic heart disease. Am Heart J 138:S366–S375PubMedCrossRefGoogle Scholar
  27. 27.
    Nesto RW, Zarich S (1998) Acute myocardial infarction in diabetes mellitus: lessons learned from ACE inhibition. Circulation 97:12–5PubMedGoogle Scholar
  28. 28.
    Zuanetti G, Latini R, Maggioni AP et al, for the GISSI-3 investigators (1997) Effect of the ACE inhibitor lisinopril on mortality in diabetic patients with acute myocardial infarction: data from the GISSI-3 study. Circulation 96:4239–45PubMedGoogle Scholar
  29. 29.
    Heart Outcomes Prevention Evaluation (HOPE) Study Investigators (2000) Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 355:253–9CrossRefGoogle Scholar
  30. 30.
    Lindholm LH, Ibsen H, Dahlöf B et al, for the LIFE study group (2002) Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359:1004–10PubMedCrossRefGoogle Scholar
  31. 31.
    Dahlöf B, Devereux RB, Kjeldsen SE et al, for the LIFE study group: cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE) (2002): a randomised trial against atenolol. Lancet 359:995–1003PubMedCrossRefGoogle Scholar
  32. 32.
    Kumagai K, Nakashima H, Urata H et al (2003) Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation. J Am Coll Cardiol 41:2197–204PubMedCrossRefGoogle Scholar
  33. 33.
    Pedersen OD, Bagger H, Køer L et al (1999) Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 100:376–80PubMedGoogle Scholar
  34. 34.
    Fortuno MA, Ravassa S, Etayo JC et al (1998) Overexpression of Bax protein and enhanced apoptosis in the left ventricle of spontaneously hypertensive rats. Effects of AT1 blockade with losartan. Hypertension 32:280–6PubMedGoogle Scholar
  35. 35.
    Nakashima H, Kumagai K, Urata H et al (2000) Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation 101: 2612–7PubMedGoogle Scholar
  36. 36.
    Kumagai K, Nakashima H et al (2003) Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation J Am Coll Cardiol 41:2197PubMedCrossRefGoogle Scholar
  37. 37.
    Madrid AH, Bueno MG, Rebollo JM et al (2002) Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation. A prospective and randomized study. Circulation 106:331–6PubMedCrossRefGoogle Scholar
  38. 38.
    Lopez B, Querejeta R, Varo N, Gonzalez A et al (2001) Usefulness of serum carboxyterminal propeptide of procollagen type I in assessment of the cardioreparative ability of antihypertensive treatment in hypertensive patients. Circulation 104:286–91PubMedGoogle Scholar
  39. 39.
    Wachtell K, Lehto M, Gerdts E et al (2005) Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study. J Am Coll Cardiol 45:712–9PubMedCrossRefGoogle Scholar
  40. 40.
    Hansson L, Zanchetti A, Carruthers SG et al (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principial results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351:1755–62PubMedCrossRefGoogle Scholar
  41. 41.
    Opie L (2000) What is the most effective management of hypertension in diabetes? Dialogues Cardiovasc Med 5:23–9Google Scholar
  42. 42.
    Syvanne M, Taskinen MR (1997) Lipids and lipoproteins as coronary risk factors in non insulin dependent diabetes mellitus. Lancet 350(Suppl 1):S120–S123Google Scholar
  43. 43.
    Pyörälä K, Pedersen TR, Kjekshus J et al (1997) Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 20:614–20PubMedCrossRefGoogle Scholar
  44. 44.
    Goldberg RB, Mellies MJ, Sacks FM et al (1998) Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. Circulation 98:2513–19PubMedGoogle Scholar
  45. 45.
    The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group (1998) Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 339:1349–57CrossRefGoogle Scholar
  46. 46.
    Stern MP (1998) The effect of glycemic control on the incidence of macrovascular complications of type 2 diabetes. Arch Fam Med 7:155–62PubMedCrossRefGoogle Scholar
  47. 47.
    Klein R (1995) Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care 18:258–68PubMedCrossRefGoogle Scholar
  48. 48.
    Moss SE, Klein R, Klein BEK et al (1994) The association of glycemia and cause-specific mortality in a diabetic population. Arch Intern Med 154:2473–9PubMedCrossRefGoogle Scholar
  49. 49.
    Gaster B, Hirsch IB (1998) The effects of improved glycemic control on complications in type 2 diabetes. Arch Intern Med 158:134–40PubMedCrossRefGoogle Scholar
  50. 50.
    Andersson DKG, Svardsudd K (1995) Long-term glycemic control relates to mortality in type II diabetes. Diabetes Care 18:1534–43PubMedCrossRefGoogle Scholar
  51. 51.
    Kuusisto J, Mykkanen L, Pyorala K et al (1994) NIDDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes 43:960–7PubMedCrossRefGoogle Scholar
  52. 52.
    Mehta S, Yususf S, Peters R et al, for the Clopidogrel in Unstable Angina to Prevent Recurrent Events trial (CURE) Investigators (2001) Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 358:527–33PubMedCrossRefGoogle Scholar
  53. 53.
    Rubins HB, Robins SJ, Collins D, Fye CL et al (1999) Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 34:410–8CrossRefGoogle Scholar
  54. 54.
    Clarke PM, Gray AM, Briggs A et al (2004) A model to estimate the lifetime health outcomes of patients with type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68). Diabetologia. 47:1747–1759PubMedCrossRefGoogle Scholar
  55. 55.
    Malmberg K, Rydén L, Efendic S (1995) A randomized study of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction: effects on 1-year mortality. J Am Coll Cardiol 26:57–65PubMedCrossRefGoogle Scholar
  56. 56.
    Malmberg K, Norhammar A, Wedel H et al (1999) Glucometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long term results from the DIGAMI study. Circulation 99:2626–32PubMedGoogle Scholar
  57. 57.
    Von Bibra H, Thrainsdottir IS, Hansen A et al (2004) Augmented metabolic control improves myocardial diastolic function and perfusion in patients with non-insulin dependent diabetes. Heart 9:1483–1484CrossRefGoogle Scholar
  58. 58.
    No authors listed (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. Task Force Report. Eur Heart J 22:1852–1923Google Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • A. Aleksova
    • 1
  • A. Perkan
    • 1
  • G. Sinagra
    • 1
  1. 1.Cardiovascular Department“Ospedali Riuniti” and University of TriesteTriesteItaly

Personalised recommendations