Yu. Horb, V. Strona, I. Komir
Government Institution “L.T.Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine”
Introduction. The problem of reducing mortality from cardiovascular disease in patients with type 2 diabetes mellitus remains a subject of particular attention in modern medicine and the whole society. Therefore, both fUrther study of the structural and functional state of the heart and blood vessels, as well as early diagnosis of myocardial lesions in patients with type 2 diabetes, which can give an opportunity to assess the risk of cardiovascular complications and to apply preventive measures against them, are relevant.
The aim of the study. To review the scientific literature on the functional status of myocardium in patients with coronary heart disease (CHD), type 2 diabetes, and heart failure.
Materials and methods. The content analysis, the systematic and comparative analysis method, the bibliosemantic method of studying the current scientific researches on the topic of functional status of the myocardium in patients with type 2 diabetes were used. Sources were searched in the medical science databases PubMed NCBI, Medline, Research Gate for keywords ischemic heart disease, type 2 diabetes, heart failure, comorbidity, myocardial functional status, cardiac and vascular remodeling. 153 sources in English and Ukrainian languages have been analyzed. The sources, which highlight the clinical and pathogenetic features of the functional status of the myocardium in patients with type 2 diabetes, were selected.
Results. Type 2 diabetes and its complications, which are often myocardial disorders, lead to the early disability of people of mainly working age. The pathogenesis of myocardial disorders in patients with type 2 diabetes involves 3 major mechanisms: cardiomyocyte damage, microcirculatory and neurovegetative disorders. Type 2 diabetes in the myocardium causes dystrophic changes, the pathogenesis of which is characterized by the primary impaired metabolism of cardiomyocytes, microangiopathy, neuropathy, as well as a decrease in the susceptibility of the left ventricular myocardium, which is associated with the development of interstitial fibrosis and disturbed fibrotic fibrosis. In patients with diabetic cardiomyopathy, all conditions for the development of disturbances of heart rhythm and conduction are created, the number and severity of arrhythmias depend on the severity of type 2 diabetes.The degree of myocardial injury in patients with type 2 diabetes is determined not only by the severity of atherosclerotic changes in the coronary arteries, but also by specific changes characteristic of complications of type 2 diabetes, in particular, by microangiopathy.
Gender analysis showed a significant increase in left ventricular and left atrial dimensions, with a more pronounced decrease in myocardial systolic function in men with type 2 diabetes, obesity, and postinfarction cardiosclerosis compared with women regardless of age. The earliest sign of myocardial damage in type 2 diabetes is the appearance of diastolic dysfunction of the left ventricle with subsequent dilatation of its cavity and the development of progressive heart failure and heart rhythm disorders. Clinical signs in patients with coronary artery disease on the background of type 2 diabetes are often nonspecific and diagnosis is not timely. Therefore, the issue of early diagnosis of diabetic heart and treatment principles is not relevant. The main factors of formation of cardiovascular diseases in type 2 diabetes, first of all, atherosclerosis and coronary heart disease (CHD) are considered, pathogenetic relationship between these comorbid conditions is analyzed. The modern views on mechanisms of impaired functional state of the myocardium and accelerated remodeling of heart and blood vessels in patients with coronary heart disease in combination with type 2 diabetes are presented. The significant role of the combination of these diseases in the formation of macro- and microvascular complications, the development of chronic heart failure (CHF), as well as a significant increase in the risk of acute cardiac events and mortality, which determines the importance and relevance of the problem of improving treatment and preventive measures.
Conclusions. The main purpose of the examination of patients with coronary heart disease and concomitant diabetes mellitus type 2 is to objectify the structural and functional state of the myocardium and peripheral vascular bed, which makes it possible to assess the risk of cardiovascular complications, to determine their diagnosis and to choose the optimal patient management tactics.
- Arutyunov GL. Diabetes mellitus and atherosclerosis: what is the optimal strategy for containing the atherosclerotic process? 2004;3(1):36-38. (Russian)
- Babiy LN, Stroganova NP, Khomenko YuO. Diastolic dysfunction of the left ventricle of the heart and its role in the development of heart failure in patients with coronary artery disease. Ukrainian Cardiology Journal. 2017;3:20-26. (Russian).
- Bazdyrev ED, Bayrakova YuV, Polikutina OM, Bezdenezhnyh NA, Slepinin YuS, Barbarash OL. The relationship of respiratory function of the lungs and the structural and functional state of the myocardium in patients with type 2 diabetes mellitus and coronary artery disease. 2015;1:4-8. (Russian).
- Goryushkina OA, Vasilyeva EM. Antioxidant therapy in the correction of oxidative stress in patients with coronary artery disease and type 2 diabetes. Bulletin of New Medical Technologies. 2013;20(2):156. (Russian).
- Gurevych MA. Features of the pathogenesis and treatment of coronary artery disease, heart failure and arterial hypertension in patients with diabetes mellitus. Clinical Medicine. 2005;1:4-9. (Russian).
- Demidova TYu. Atherosclerosis and type 2 diabetes mellitus: mechanisms and management. CardioSomatica. 2011;2:22-30. (Russian).
- Dolzhenko MM, Perepelchenko NA, Bazilevych AA. Coronary artery disease in case of type 2 diabetes mellitus: peculiarities of the course and therapy justification. Kyiv; 2010. 82 p. (Ukrainian)
- Druzhilov MA, Beteleva YuE, Druzhilova OYu, Andreeva ES, Kuznetsova TYu. The role of epicardial obesity in the development of structural and functional remodeling of the heart. Russian Journal of Cardiology. 2017;144(4):35-39. (Russian). https://doi.org/10.15829/1560-4071-2017-4-35-39
- Yena LM, Yarosh VO, Artemenko VO, Khristoforova GM. Hormonal homeostasis and its relationship with the morphofunctional state of the cardiovascular system in patients with chronic heart failure with preserved ejection fraction. Heart Failure and Comorbid Conditions. 2017;3:42-46. (Ukrainian)
- Efimov AS, Skrobonskaya NA. Clinical Diabetology. Kyiv: Health; 1998. 320 p. (Russian).
- Efimov A, Skrobonskaya NA, Zuєva N. Diabetic neuropathy. Faces of Ukraine. 2005;3:21-25. (Russian).
- Zhuravlova LV, Lopina NA, Kuznetsov IV, Konoz VP, Bondarenko DO. Disorders of lipid metabolism in patients with coronary artery disease depending on the presence of type 2 diabetes mellitus and the nature of coronary artery disease. Heart and Blood Vessels. 2016;2:63-71. (Ukrainian)
- Zelinsky BA. Functional state of the cardiovascular system in diabetes mellitus. Kyiv; 2004. 225 p. (Ukrainian)
- Kyyak YuG, Kyyak GYu, Barnett OYu. The specificity of diabetic cardiomyopathy in the presence of comorbid cardiovascular diseases: clinical and ultrastructural studies. International Journal of Endocrinology. 2016;5(77):33-38. (Ukrainian). https://doi.org/10.22141/2224-0722.214.171.1246.78751
- Kravchun PP. Gender and age-specific features of cardiac remodeling in patients with post-infarction cardiosclerosis, type 2 diabetes mellitus, and obesity. International Journal of Endocrinology. 2015;2(66):20-24. (Ukrainian). https://doi.org/10.22141/2224-07126.96.36.1995.75431
- Martyshyn OO. Metabolic, endocrine, and cardiovascular diseases: an interdisciplinary approach to the diagnosis and treatment. Ukrainian Medical Journal. 2017;11/12(122):1-4. (Ukrainian)
- Mikhalchishin GP, Zilov AB. Modern strategies for managing patients with type 2 diabetes mellitus: the focus is on the prevention of cardiovascular complications. Health of Ukraine. 2008;21-24:48-49. (Russian)
- Mokryy VYa, Zyablitsev SV, Boris RM. Disorders of lipid peroxidation in type 2 diabetes mellitus (literature review). International Journal of Endocrinology. 2015;7(71):41-44. (Ukrainian). https://doi.org/10.22141/2224-07188.8.131.525.72595
- Obrezan AG, Bitsadze RM. The structure of cardiovascular diseases in patients with type 2 diabetes mellitus, diabetic cardiomyopathy as a special condition of the myocardium. International Endocrinology Journal. 2010;4(28):18-22. (Russian)
- Recommendations for diabetes, prediabetes and cardiovascular diseases. EASD/ESC. Russian Journal of Cardiology. 2014;107:7-61. (Russian)
- Rybchenko YuB, Sokolova LC. Damage to the heart in case of diabetes mellitus: risk factors and development mechanisms. Ukrainian Medical Bulletin. 2004;4(42):92-99. (Russian)
- Savchenko IP. Optimization of diagnosis and treatment of patients with complicated myocardial infarction with type 2 diabetes mellitus. International Journal of Endocrinology. 2015;3(67):161-165. (Ukrainian). https://doi.org/10.22141/2224-07184.108.40.2065.75289
- Serik SA. Insulin resistance and free fatty acids in case of heart failure in patients with coronary artery disease with type 2 diabetes mellitus. Ukrainian Therapeutic Journal. 2010;3(27):51-54. (Russian)
- Sokolov EI. Diabetic heart. Moscow: Medicine; 2002. 416 p. (Russian)
- Sokolova LC, Pushkaryov VM, Kovzun EI, Pushkaryov VV, Tronko ND. Diabetes mellitus and atherosclerosis: epigenetic mechanisms of pathogenesis. Literature review. Ukrainian Cardiology Journal. 2017;6:104-117. (Russian)
- Unified clinical protocol for primary and secondary (specialized) medical care: type 2 diabetes: Order of Ministry of Health of Ukraine N 1118 dated Dec 21, 2012. 115 p. (Ukrainian)
- American Diabetes Association: Clinical practice recommendations 2006. Diabetes Care. 2006;29(1 suppl):1-85.
- American Diabetes Association’s Standards of Medical Care in Diabetes2018. Diabetes Care. 2018;41(1 suppl):1-159. https://doi.org/10.2337/dc18-S015
- Arror AR. Insulin resistance and heart failure: molecular mechanisms. Heart Fail Clin. 2012;8(4):3133-3140. https://doi.org/10.1016/j.hfc.2012.06.005
- Balkau B, Eschwege E. Insulin resistance: an independent risk factor for cardiovascular disease? Diabetes ObesityMetab. 1999;1(1s):23-31. https://doi.org/10.1046/j.1463-1326.1999.0010s1023.x
- Biegelsen ES, Loscalzo J. Endotehelial function and aterosclerosis. Coron Artery Dis. 1999;10(4):241-256. https://doi.org/10.1097/00019501-199906000-00006
- Bugger H, Dale E. Molecular mechanisms of diabetic cardiomyopathy. Diabetologia. 2014;57(4):660-671. https://doi.org/10.1007/s00125-014-3171-6
- Després JP. Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk. Eur Heart J. 2006;8(B suppl):4-12. https://doi.org/10.1093/eurheartj/sul002
- Engstrom G, Hedblad B, Nilsson P, Wollmer P, Berglund G, Janzon L. Lung function insulin resistance and incidence of cardiovascular disease: a longitudinal cohort study. J Inter Med. 2003;253:574-581. https://doi.org/10.1046/j.1365-2796.2003.01138.x
- Feskens EJ, Kromhout D. Glucose tolerance and the risk of cardiovascular disease: the Zutphen Study. J Clin Epidemiol. 2005;45(11):1327-1334. https://doi.org/10.1016/0895-4356(92)90173-K
- Goldfine AB, Phua EJ, Abrahamson MJ. Glycemic mana¬gement in patientswith coronary artery disease and prediabetes or type 2 diabetes mellitus. Circulation. 2014;129(24):2567-2573. https://doi.org/10.1161/CIRCULATIONAHA.113.006634
- Guidelines ondiabetes, prediabetes, and cardiovascular diseases: executive summary. Eur Heart J. 2007;28(1):88-136.
- Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ. 2016;355:i5953. https://doi.org/10.1136/bmj.i5953
- Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. 2006;332(7533):73-78. https://doi.org/10.1136/bmj.38678.389583.7C
- Kass DA, Bronzwaer JG, Paulus WJ. What mechanisms underlie diastolic dysfunction in heart failure? Circulation Research. 2004;94(12):1533-1542. https://doi.org/10.1161/01.RES.0000129254.25507.d6
- Lehnert SE, Maier LS, Hassenfuss G. Abnormalilities of calcium metabolism and myocardial depression in failing heart. Heart Failure Res. 2009;14:213-224. https://doi.org/10.1007/s10741-009-9146-x
- Marks JB, Raskin P. Cardiovascular risk in diabetes. J Diabet Complicat. 2000;14:108-115. https://doi.org/10.1016/S1056-8727(00)00065-9
- Montori VM, Wang YG, Alonso-Coello P, Bhagra S. Systematic evaluation of the quality of randomized controlled trials in diabetes. Diabetes Care. 2006;29(8):1833-1838. https://doi.org/10.2337/dc06-0077
- Naito R, Kasai T. Coronary artery disease in type 2 diabetes mellitus: Recent treatmentstrategies and future perspectives. World J Cardiol. 2015;7(3):119-124. https://doi.org/10.4330/wjc.v7.i3.119
- Nichols GA, Hillier TA, Erbey JR, Brown JB. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factor. Diabetes Сare. 2001;24(9):1614-1619. https://doi.org/10.2337/diacare.24.9.1614
- Ramachandran S. Defining Diastolic Heart Failure. Circulation. 2006;101:2118-2121. https://doi.org/10.1161/01.CIR.101.17.2118
- Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37:1595-1607. https://doi.org/10.2337/diab.37.12.1595
- Standards of medical care in diabetes – 2016. American Diabetes Association. Diabetes Care. 2016; 39(1 suppl):1-109. https://doi.org/10.2337/dc16-S003
- Steiner G. Risk factors for macrovascular disease in type 2 diabetes. Classic Lipid Abnormalities. Diabet Care. 1999;3:6-9.
- Timmis AD. Diabetic heart disease: clinical considerations. Heart. 2005;89(4):463-469. https://doi.org/10.1136/heart.85.4.463
- UK Prospective Diabetes Group. Tight blood pressure control and risk of macrovascular and microvascular complication sin type 2 diabetes: UKPDS 38. BMJ. 1998;317:703-713. https://doi.org/10.1136/bmj.317.7160.703
- Wannamethee SG, Shaper AG, Lennon L. Cardiovascular disease incidence and mortality in older men with diabetes and in men with coronary heart disease. 2004;90(12):1398-1403. https://doi.org/10.1136/hrt.2003.026104
- Yeh HC, Punjabi NM, Wang NY, Pankow JS,Duncan BB, Cox CE et al. Cross-sectional and prospective study of lung function in adults with type 2 diabetes: the atherosclerosis risk in communities study. Diabet Care. 2008;31(4):741-746. https://doi.org/10.2337/dc07-1464
- Young LH, Wackers FJ, Chyun DA, Davey JA, Barrett EJ, Taillefer R et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. 2009;301(15):1547-1555. https://doi.org/10.1001/jama.2009.476
- Zhang Y, Janssens SP, Wingler K, Schmidt HH, Moens AL. Modulating endothelial nitric oxide synthase: a new cardiovascular therapeutic strategy.Am J Physiol Heart Circ Physiol. 2011;301(3):H634-H646. https://doi.org/10.1152/ajpheart.01315.2010