Dr Javed Butler Discusses Why People With Diabetes Are at Greater Risk of Heart Failure

There are multiple ways in which people with diabetes can develop heart failure, which is why heightened awareness through the initiative Diabetes Can Break Your Heart is warranted, said Javed Butler, MD, MPH, MBA, professor of physiology and chairman for the Department of Medicine at the University of Mississippi.

Can you discuss the purpose of the initiative Diabetes Can Break Your Heart?

The purpose of the initiative Diabetes Can Break Your Heart is to increase awareness of the link between diabetes and heart failure. Patients with diabetes are at a particularly higher risk for cardiovascular adverse events, high risk for heart attack, high risk for stroke, high risk for peripheral vascular disease, dialysis, and kidney failure–all of these things you've been worrying about for a very long time and we try to lower the risk as much as possible. Having said that, the risk for heart failure, if anything, maybe a little bit stronger, or at least equal, so there is clearly a risk for heart failure; but the bigger issue is that once these patients develop heart failure, they have really bad outcomes. The combination of heart failure and diabetes is really a bad combination.

However, unlike the risk for heart attack, we don't necessarily think about the risk for heart failure as such. So, the reason for this initiative is to bring a broader awareness for the risk of developing heart failure–what are the things to look out for, what can we do about it, and how sort of the public and patients with diabetes and the communities be a little bit more engaged about this issue.

Why are people with diabetes at greater risk of heart failure, and why are their early symptoms of heart failure often overlooked?

If you look at overall why patients developed with heart failure just in general, the 2 biggest risk factors are coronary artery disease and hypertension–both of them are more common in patients with diabetes. Patients with diabetes are at a higher risk of developing hypertension and a higher risk of developing coronary artery disease and myocardial infarction. So, that is 1 pathway through which they can develop heart failure.

There are other issues also–for example, chronic kidney disease is a major complication of patients with diabetes and chronic kidney disease certainly is linked to heart failure as well; but we are also fascinated by these alternate mechanisms on why the metabolic changes in the heart by itself that you see patients with diabetes can cause something that we call diabetic cardiomyopathy. Then finally, there is the systemic effect of obesity cardiometabolic sort of stage related to inflammation and oxidative stress or the milieu, in which a patient with diabetes lives in–that also puts the patients at high risk for heart failure. So, it's really not 1 particular pathway, but there are multiple ways by which people can develop heart failure and that's why they're high risk. The problem is that although there are multiple pathways, they are not distinct. So, most patients with diabetes actually have more than 1 of these abnormalities at the same time and that really escalates the risk of developing heart failure.
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