Heart Failure and Diabetes Mellitus: Defining the Problem and Exploring the Interrelationship

Sitagliptin, diabetes mellitus, and heart failure: an in-depth review of sitagliptin therapy and heart failure in patients with diabetes mellitus

Heart failure (HF) is characterized by impairments in cardiac function and heart structural changes. Type-2 diabetes mellitus (T2DM) is a chronic metabolic disorder affecting millions worldwide. It is a risk factor for cardiovascular disease. Patients with T2DM are at an increased risk of developing HF. Multifactorial pathophysiology underlies HF in T2DM patients. Inflammation, oxidative stress, insulin resistance, and endothelial dysfunction are some of the mechanisms involved. Dipeptidyl peptidase-4 (DPP-IV) inhibitors may affect cardiac function by modulating inflammation and oxidative stress, affecting endothelial function, and modifying myocardial fibrosis. An antidiabetic drug class known as DPP-IV inhibitors improves patients' glycemic control in T2DM patients. However, DPP-IV inhibitors have been shown to lower glucose levels and alter HF risk in addition to their glucose-lowering effects. Sitagliptin is an oral medication used to treat T2DM. Sitagliptin is often used in combination with other diabetes medications. A preclinical study showed that sitagliptin improved cardiac function in models of heart failure. The precise mechanisms responsible for this improvement are not yet fully understood, but it could be related to inflammation and oxidative stress. Patients with T2DM are more prone to HF, which highlights the necessity of effective therapies to improve both blood glucose control and cardiovascular health. Sitagliptin offers potential cardioprotective and glucose-lowering benefits for these patients. However, further research is required to fully comprehend the role of sitagliptin in the treatment of HF in individuals with T2DM.

Protective Effects of Flavonoids in Diabetic Cardiomyopathy: A Comprehensive Review on the Mechanistic Insights

Diabetic cardiomyopathy (DCM) is one of the leading causes of mortality among diabetic patients. Flavonoid are the most abundant group of phytochemicals in fruits and vegetables, and have received increasing interest as potential chemopreventive antidiabetic agents. Flavonoids might contribute to prevent or delay DCM by regulating the cardiac metabolism, insulin signaling, oxidative stress, apoptosis, autophagy, and inflammation. Among other effects, flavonoids have been proved to enhance glucose uptake, decrease cellular lipid accumulation, or suppress oxidative stress. However, the mechanistic basis of these effects is not fully understood, and many points remain to be clarified. This review provides insight into the molecular mechanisms of flavonoid chemopreventive activity by summarizing cell culture and animal model studies.

Sudden cardiac death due to ventricular arrhythmia in diabetes mellitus: A bench to bedside review

Diabetes mellitus (DM) confers an increased risk of sudden cardiac death (SCD) independent of its associated cardiovascular comorbidities. DM induces adverse structural, electrophysiologic, and autonomic cardiac remodeling that can increase one's risk of ventricular arrhythmias and SCD. Although glycemic control and prevention of microvascular and macrovascular complications are cornerstones in the management of DM, they are not adequate for the prevention of SCD. In this narrative review, we describe the contribution of DM to the pathophysiologic mechanism of SCD beyond its role in atherosclerotic cardiovascular disease and heart failure. On the basis of this pathophysiologic framework, we outline potential preventive and therapeutic strategies to mitigate the risk of SCD in this population of high-risk patients.

Sodium-Glucose Transporter 2 Inhibitors in Heart Failure: An Overview of Systematic Reviews

Background: Several studies have shown that sodium-dependent glucose transporter 2 inhibitors can be used in the treatment of heart failure. This article summarized systematic reviews of sodium-dependent glucose transporter 2 inhibitors in the treatment of heart failure in order to evaluate efficacy and safety. Methods: We systematically searched eight electronic databases from inception to July 2023. We used Assessment of Multiple Systematic Reviews 2 to evaluate the methodological quality, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 to assess report quality, Risk of Bias in Systematic Review to assess the risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation to rate the quality of evidence. Outcome: A total of 36 systematic reviews were included. Our results were classified as clear evidence of benefit: hospitalization for heart failure; possible benefit: cardiovascular death (mortality) and renal outcome composite; clear evidence of no effect or equivalence: atrial arrhythmias, ventricular arrhythmia, atrial fibrillation, and hypotension; possible harm: genital infection; insufficient evidence to draw a conclusion: atrial flutter, major adverse cardiovascular events, urinary tract infection, acute kidney injury, hypoglycemia, and bone fracture. Conclusions: Sodium-dependent glucose transporter 2 inhibitors are beneficial for the treatment of heart failure, especially in terms of heart failure hospitalization.

Prevalence of diabetic cardiomyopathy in patients with type 2 diabetes in a large academic medical center

BACKGROUND

Diabetic cardiomyopathy (DbCM) is characterized by asymptomatic stage B heart failure (SBHF) caused by diabetes-related metabolic alterations. DbCM is associated with an increased risk of progression to overt heart failure (HF). The prevalence of DbCM in patients with type 2 diabetes (T2D) is not well established. This study aims to determine prevalence of DbCM in adult T2D patients in real-world clinical practice.

METHODS

Retrospective multi-step review of electronic medical records of patients with the diagnosis of T2D who had echocardiogram at UC San Diego Medical Center (UCSD) within 2010-2019 was conducted to identify T2D patients with SBHF. We defined "pure" DbCM when SBHF is associated solely with T2D and "mixed" SBHF when other medical conditions can contribute to SBHF. "Pure" DbCM was diagnosed in T2D patients with echocardiographic demonstration of SBHF defined as left atrial (LA) enlargement (LAE), as evidenced by LA volume index ≥ 34 mL/m2, in the presence of left ventricular ejection fraction (LVEF) ≥ 45%, while excluding overt HF and comorbidities that can contribute to SBHF.

RESULTS

Of 778,314 UCSD patients in 2010-2019, 45,600 (5.9%) had T2D diagnosis. In this group, 15,182 T2D patients (33.3%) had echocardiogram and, among them, 13,680 (90.1%) had LVEF ≥ 45%. Out of 13,680 patients, 4,790 patients had LAE. Of them, 1,070 patients were excluded due to incomplete data and/or a lack of confirmed T2D according to the American Diabetes Association recommendations. Thus, 3,720 T2D patients with LVEF ≥ 45% and LAE were identified, regardless of HF symptoms. In this group, 1,604 patients (43.1%) had overt HF and were excluded. Thus, 2,116 T2D patients (56.9% of T2D patients with LVEF ≥ 45% and LAE) with asymptomatic SBHF were identified. Out of them, 1,773 patients (83.8%) were diagnosed with "mixed" SBHF due to comorbidities such as hypertension (58%), coronary artery disease (36%), and valvular heart disease (17%). Finally, 343 patients met the diagnostic criteria of "pure" DbCM, which represents 16.2% of T2D patients with SBHF, i.e., at least 2.9% of the entire T2D population in this study.

CONCLUSIONS

Our findings provide insights into prevalence of DbCM in real-world clinical practice and indicate that DbCM affects a significant portion of T2D patients.

(-)-Epicatechin and colonic metabolite 2,3-dihydroxybenzoic acid, alone or in combination with metformin, protect cardiomyocytes from high glucose/high palmitic acid-induced damage by regulating redox status, apoptosis and autophagy

(-)-Epicatechin (EC) and a main colonic phenolic acid derived from flavonoid intake, 2,3-dihydroxybenzoic acid (DHBA), display antioxidant and antidiabetic activities. Diabetic cardiomyopathy (DCM) is one of the main causes of mortality in patients with diabetes, lacking a suitable treatment. Hyperglycaemia and dyslipidaemia are mainly responsible for oxidative stress and altered apoptosis and autophagy in cardiomyocytes during DCM. In this context, phenolic compounds could be suitable candidates for alleviating DCM, but have scarcely been investigated or their use in combination with antidiabetic drugs. This study evaluates the effects of EC, DHBA and antidiabetic drug metformin (MET), alone or all combined (MIX), on redox status, autophagy and apoptosis in H9c2 cardiomyocytes challenged with high concentrations of glucose (HG) and palmitic acid (PA). Under HG + PA conditions, EC, DHBA, MET and MIX equally improved redox status, reduced apoptosis induction and ameliorated autophagy inhibition. Mechanistically, all treatments alleviated HG + PA-induced oxidative stress by reinforcing antioxidant defences (∼40% increase in glutathione, ∼30% diminution in GPx activity and ∼15% increase in SOD activity) and reducing ROS generation (∼20%), protein oxidation (∼35%) and JNK phosphorylation (∼200%). Additionally, all treatments mitigated HG + PA-induced apoptosis and activated autophagy by decreasing Bax (∼15-25%), caspase-3 (∼20-40%) and p62 (∼20-40%), and increasing Bcl-2, beclin-1 and LC3-II/LC3-I (∼40-60%, ∼15-20%, and ∼25-30%, respectively). JNK inhibition improved protective changes to redox status, apoptosis and autophagy that were observed in EC-, DHBA- and MIX-mediated protection. Despite no additive or synergistic effects being detected when phenolic compounds and MET were combined, these results provide the first evidence for the benefits of EC and DHBA, comparable to those of MET alone, to ameliorate cardiomyocyte damage, that involve an improvement in antioxidant competence, autophagy and apoptosis, these effects being mediated at least by targeting JNK.

Cardiorenal syndrome and diabetes: an evil pairing

Cardiorenal syndrome (CRS) is a pathology where the heart and kidney are involved, and the deterioration of one of them leads to the malfunction of the other. Diabetes mellitus (DM) carries a higher risk of HF and a worse prognosis. Furthermore, almost half of people with DM will have chronic kidney disease (CKD), which means that DM is the main cause of kidney failure. The triad of cardiorenal syndrome and diabetes is known to be associated with increased risk of hospitalization and mortality. Cardiorenal units, with a multidisciplinary team (cardiologist, nephrologist, nursing), multiple tools for diagnosis, as well as new treatments that help to better control cardio-renal-metabolic patients, offer holistic management of patients with CRS. In recent years, the appearance of drugs such as sodium-glucose cotransporter type 2 inhibitors, have shown cardiovascular benefits, initially in patients with type 2 DM and later in CKD and heart failure with and without DM2, offering a new therapeutic opportunity, especially for cardiorenal patients. In addition, glucagon-like peptide-1 receptor agonists have shown CV benefits in patients with DM and CV disease in addition to a reduced risk of CKD progression.

Inflammatory Macrophage Interleukin-1β Mediates High-Fat Diet-Induced Heart Failure With Preserved Ejection Fraction

Diabetes mellitus (DM) is a main risk factor for diastolic dysfunction (DD) and heart failure with preserved ejection fraction. High-fat diet (HFD) mice presented with diabetes mellitus, DD, higher cardiac interleukin (IL)-1β levels, and proinflammatory cardiac macrophage accumulation. DD was significantly ameliorated by suppressing IL-1β signaling or depleting macrophages. Mice with macrophages unable to adopt a proinflammatory phenotype were low in cardiac IL-1β levels and were resistant to HFD-induced DD. IL-1β enhanced mitochondrial reactive oxygen species (mitoROS) in cardiomyocytes, and scavenging mitoROS improved HFD-induced DD. In conclusion, macrophage-mediated inflammation contributed to HFD-associated DD through IL-1β and mitoROS production.

Predicting incident heart failure among patients with type 2 diabetes mellitus: The DM-CURE risk score

AIM

Early identification and prediction of incident heart failure (HF) is important because of severe morbidity and mortality. This study aimed to predict onset of HF among patients with diabetes.

METHODS

A time-varying Cox model was derived from ACCORD clinical trial to predict the risk of incident HF, defined by hospitalization for HF (HHF). External validation was performed on patient-level data from the Harmony Outcome trial and Chronic Renal Insufficiency Cohort (CRIC) study. The model was transformed into an integer-based scoring algorithm for 10-year risk evaluation. A stepwise algorithm identified and selected predictors from demographic characteristics, physical examination, laboratory results, medical history, medication and health care utilization, to develop a risk prediction model. The main outcome was incident HF, defined by HHF. The C statistic and Brier score were used to assess model performance.

RESULTS

In total, 9649 patients with diabetes free of HF were used, with median follow-up of 4 years and 299 incident hospitalization of HF events. The model identified several predictors for the 10-year HF incidence risk score 'DM-CURE': socio-Demographic [education, age at type 2 diabetes (T2DM) diagnosis], Metabolic (glycated haemoglobin, systolic blood pressure, body mass index, high-density lipoproteins), diabetes-related Complications (myocardial infarction, revascularization, cardiovascular medications, neuropathy, hypertension duration, albuminuria, urine albumin-to-creatinine ratio, End Stage Kidney Disease), and health care Utilization (all-cause hospitalization, emergency room visits) for Risk Evaluation. Among them, the strongest impact factors for future HF were age at T2DM diagnosis, health care utilization and cardiovascular disease-related variables. The model showed good discrimination (C statistic: 0.838, 95% CI: 0.821-0.855) and calibration (Brier score: 0.006, 95% CI: 0.006-0.007) in the ACCORD data and good performance in the validation data (Harmony: C statistic: 0.881, 95% CI: 0.863-0.899; CRIC: C statistic: 0.813, 95% CI: 0.794-0.833). The 10-year risk of incident HF increased in a graded fashion, from ≤1% in quintile 1 (score ≤14), 1%-5% in quintile 2 (score 15-23), 5%-10% in quintile 3 (score 24-27), 10%-20% in quintile 4 (score 28-33) and ≥20% in quintile 5 (score >33).

CONCLUSIONS

The DM-CURE model and score were useful for population risk stratification of incident HHF among patients with T2DM and can be easily applied in clinical practice.

Development of Prediction Model to Estimate the Risk of Heart Failure in Diabetes Mellitus

Background

Heart failure (HF) is a leading cause of mortality and disability in patients with diabetes mellitus (DM). The aim of the study is to predict the risk of HF incidence in patients with DM by developing a risk prediction model.

Methods

We constructed a regression model based on 270 inpatients with DM between February 2018 and January 2019. Binary logistic regression was applied to develop the final model incorporating the predictors selected by least absolute shrinkage and selection operator regression. The nomogram was estimated with an area under the receiver operator characteristic curve and calibration diagram and validated with the bootstrap method.

Results

Risk factors including age, coronary heart disease (CHD), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were incorporated in the final model as predictors. Age ≥ 61 years old, LDL, and CHD were risk factors for DM with HF, with odds ratios (ORs) of 32.84 (95% CI: 6.74, 253.99), 1.33 (95% CI: 1.06, 1.72), and 3.94 (95% CI: 1.43, 13.43), respectively. HDL was a protective factor with an OR of 0.11 (95% CI: 0.04, 0.28). The area under curve of the model was 0.863 (95% confidence interval, 0.812∼0.913). The plot of the calibration showed that there was a good consistency between predicted probability and actual probability. Harrell’s C-index of the nomogram was 0.845, and the model showed satisfactory calibration in the internal validation cohort.

Conclusion

The prediction nomogram we developed can estimate the possibility of HF in patients with DM according the predictor items.

Metabolic regulation of (-)-epicatechin and the colonic metabolite 2,3-dihydroxybenzoic acid on the glucose uptake, lipid accumulation and insulin signalling in cardiac H9c2 cells

Epicatechin (EC) and main colonic phenolic acids derived from flavonoid intake have been suggested to exert healthful effects, although their mechanism of action remains unknown. Heart damage is highly prevalent in metabolic diseases, and the failure of this organ is a major cause of death worldwide. In this study, the modulation of the energy metabolism and insulin signalling by the mentioned compounds in cardiac H9c2 cells was evaluated. Incubation of cells with EC (1-20 μM) and 2,3-dihydroxybenzoic acid (DHBA, 10 μM) reduced glucose uptake, and both compounds decreased lipid accumulation at concentrations higher than 0.5 μM. EC and DHBA also increased the tyrosine phosphorylated and total insulin receptor (IR) levels, and activated the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) pathway in cardiac H9c2 cells. Interestingly, EC and DHBA did not modify glucose transporters (SGLT-1 and GLUT-1) levels, and increased GLUT-4 values. In addition, EC and DHBA decreased cluster of differentiation 36 (CD36) and fatty acid synthase (FAS) values, and enhanced carnitine palmitoyl transferase 1 (CPT1) and proliferator activated receptor α (PPARα) levels. By using specific inhibitors of AKT and 5'-AMP-activated protein kinase (AMPK), the participation of both proteins in EC- and DHBA-mediated regulation on glucose uptake and lipid accumulation was shown. Taken together, EC and DHBA modulate glucose uptake and lipid accumulation via AKT and AMPK, and reinforce the insulin signalling by activating key proteins of this pathway in H9c2 cells.

Impact of insulin therapy on outcomes of diabetic patients with heart failure: A systematic review and meta-analysis

OBJECTIVE

To compare clinical outcomes in diabetic patients with heart failure managed by insulin with those managed by non-insulin (oral hypoglycemic agents and/or lifestyle modification) based therapy.

METHODS

PubMed and Scopus databases were searched for studies conducted on diabetic patients with heart failure. Studies were to compare outcomes of patients managed by insulin versus non-insulin therapies.

RESULTS

15 studies were included. Compared to those who were managed using non-insulin therapy, insulin-treated patients had increased risk of all-cause mortality (RR 1.46, 95% CI: 1.14, 1.88) and cardiovascular specific mortality (RR 1.62, 95% CI: 1.33, 1.96). Those managed using insulin also had increased risk of hospitalization (RR 1.45, 95% CI: 1.09, 1.93) and readmission (RR 1.49, 95% CI: 1.32, 1.67). There was no additional risk for stroke (RR 1.07, 95% CI: 0.91, 1.27) or myocardial infarction (MI) (RR 1.10, 95% CI: 0.96, 1.27) between the two groups of patients.

CONCLUSIONS

Receipt of insulin among diabetic patients with heart failure was associated with an increased risk of mortality, hospitalization and readmission compared to management using oral hypoglycemic agents and/or lifestyle modification. Such patients should be closely monitored for any adverse events.

Lifestyle and Cardiovascular Risk Factors Associated With Heart Failure Subtypes in Postmenopausal Breast Cancer Survivors

Background

Breast cancer (BC) survivors experience an increased burden of long-term comorbidities, including heart failure (HF). However, there is limited understanding of the risk for the development of HF subtypes, such as HF with preserved ejection fraction (HFpEF), in BC survivors.

Objectives

This study sought to estimate the incidence of HFpEF and HF with reduced ejection fraction (HFrEF) in postmenopausal BC survivors and to identify lifestyle and cardiovascular risk factors associated with HF subtypes.

Methods

Within the Women’s Health Initiative, participants with an adjudicated diagnosis of invasive BC were followed to determine the incidence of hospitalized HF, for which adjudication procedures determined left ventricular ejection fraction. We calculated cumulative incidences of HF, HFpEF, and HFrEF. We estimated HRs for risk factors in relation to HF, HFpEF, and HFrEF using Cox proportional hazards survival models.

Results

In 2,272 BC survivors (28.6% Black and 64.9% White), the cumulative incidences of hospitalized HFpEF and HFrEF were 6.68% and 3.96%, respectively, over a median of 7.2 years (IQR: 3.6-12.3 years). For HFpEF, prior myocardial infarction (HR: 2.83; 95% CI: 1.28-6.28), greater waist circumference (HR: 1.99; 95% CI: 1.14-3.49), and smoking history (HR: 1.65; 95% CI: 1.01-2.67) were the strongest risk factors in multivariable models. With the exception of waist circumference, similar patterns were observed for HFrEF, although none were significant. In relation to those without HF, the risk of overall mortality in BC survivors with hospitalized HFpEF was 5.65 (95% CI: 4.11-7.76), and in those with hospitalized HFrEF, it was 3.77 (95% CI: 2.51-5.66).

Conclusions

In this population of older, racially diverse BC survivors, the incidence of HFpEF, as defined by HF hospitalizations, was higher than HFrEF. HF was also associated with an increased mortality risk. Risk factors for HF were largely similar to the general population with the exception of prior myocardial infarction for HFpEF. Notably, both waist circumference and smoking represent potentially modifiable factors.

Clinical Characteristics, Management, and In-Hospital Mortality in Patients with Heart Failure with Reduced Ejection Fraction According to Sex and the Presence of Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is a risk factor for the development of heart failure with reduced ejection fraction (HFrEF). Aims: (1) To describe and compare the clinical characteristics and the use of diagnostic and therapeutic procedures among subjects hospitalized with HFrEF according to the presence of type 2 diabetes mellitus (T2DM) and sex; (2) to assess the effect of T2DM and sex on hospital outcomes among the patients hospitalized with HFrEF using propensity score matching (PSM); and (3) to identify which clinical variables were associated to in-hospital mortality (IHM) among the patients hospitalized with HFrEF and T2DM according to their sex. Methods: A retrospective cohort study from 2016 to 2019 using the Spanish National Hospital Discharge Database was conducted. The diagnosis and procedures were codified with the International Classification of Disease 10th version (ICD10). Subjects aged ≥ 40 with a primary diagnosis of HFrEF were included. We included those patients with a diagnosis of T2DM in any diagnosis position. The descriptive statistics used were total and relative frequencies (percentages), means with standard deviations, and medians with an interquartile range. To control the effect of confounding variables when T2DM patients and non-T2DM patients were compared, we matched the cohorts using PSM. Multivariable logistic regression models were used to identify which study variables independently affected the IHM among men and women with HF and T2DM. Also, this multivariable method was applied for sensitivity analyses to confirm the results of the PSM. Results: A total of 28,894 patients were included. T2DM was present in 39.59%. Women with T2DM more frequently had atrial fibrillation, valvular heart disease, anemia, dementia, depression, and hyponatremia than men with T2DM. However, men had more coronary heart disease, chronic renal disease, COPD, and obstructive sleep apnea. All the procedures were significantly more commonly used among men than women. Blood transfusion was the only procedure more frequently identified among women with T2DM. For the sensitivity analysis in patients with T2DM hospitalized with HFrEF, we confirmed the results of the PSM, finding that women had a 14% higher risk of dying in the hospital than men (OR 1.14; 95% CI 1.01–1.35). Obesity seemed to have a protective effect (OR 0.85; 95% CI 0.73–0.98) on the in-hospital morality. Conclusions: Subjects with diabetes are admitted for HFrEF and have a greater number of comorbidities than non-diabetics. Diabetic women have a higher mortality rate than men with diabetes and all the procedures evaluated were significantly more often used among men than women.

Use of disease-modifying drugs in diabetic patients with heart failure with reduced ejection fraction

Type 2 diabetes mellitus and heart failure are closely related, patients with type 2 diabetes mellitus have a higher risk of developing heart failure, and those with heart failure are at increased risk of developing type 2 diabetes. Although no specific randomized clinical trials have been conducted to test the effect of cardiovascular therapies (drugs and/or devices) in diabetic patients with heart failure, a lot of evidence shows that all interventions effective in improving prognosis in patients with heart failure reduced ejection fraction are equally beneficial in patients with and without diabetes. However, the use of disease-modifying drugs in patients with diabetes and heart failure reduced ejection fraction is a clinical challenge due to the increased risk of adverse effects. For example, β-blockers are underutilized in diabetic patients due to the theoretical unfavorable effects on glucose metabolism as well as the use of drugs that interact with the renin-angiotensin system can be challenged in patients with diabetic nephropathy because of the risk of hyperkalemia. This review outlines the current use of disease-modifying drugs in diabetic patients with heart failure reduced ejection fraction. In addition, the role of novel pharmacologic agents as type 2 sodium-glucose co-transporter inhibitors (SGLT2ii) is discussed.

2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

2021 ISHNE / HRS / EHRA / APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society describes the current status of mobile health technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mobile health. The promises of predictive analytics but also operational challenges in embedding mobile health into routine clinical care are explored.

Cardio- and reno-protective effects of dipeptidyl peptidase III in diabetic mice

Diabetes mellitus (DM) causes injury to tissues and organs, including to the heart and kidney, resulting in increased morbidity and mortality. Thus, novel potential therapeutics are continuously required to minimize DM-related organ damage. We have previously shown that dipeptidyl peptidase III (DPPIII) has beneficial roles in a hypertensive mouse model, but it is unknown whether DPPIII has any effects on DM. In this study, we found that intravenous administration of recombinant DPPIII in diabetic db/db mice for 8 weeks suppressed the DM-induced cardiac diastolic dysfunctions and renal injury without alteration of the blood glucose level. This treatment inhibited inflammatory cell infiltration and fibrosis in the heart and blocked the increase in albuminuria by attenuating the disruption of the glomerular microvasculature and inhibiting the effacement of podocyte foot processes in the kidney. The beneficial role of DPPIII was, at least in part, mediated by the cleavage of a cytotoxic peptide, named Peptide 2, which was increased in db/db mice compared with normal mice. This peptide consisted of nine amino acids, was a digested fragment of complement component 3 (C3), and had an anaphylatoxin-like effect determined by the Miles assay and chemoattractant analysis. The effect was dependent on its interaction with the C3a receptor and protein kinase C-mediated RhoA activation downstream of the receptor in endothelial cells. In conclusion, DPPIII plays a protective role in the heart and kidney in a DM animal model through cleavage of a peptide that is a part of C3.

Diabetes and cardiovascular disease: inter-relation of risk factors and treatment

Background

The diabetes mellitus prevalence is still advancing and increasingly becoming one of the globally most severe and expensive chronic illnesses. The strong correlation between diabetes as well as the most prominent reason for diabetes and death in diabetic patients is cardiovascular disorders. Health conditions like dyslipidemia, hypertension, obesity, and other factors of risk like the risk of cardiovascular are frequent in diabetic persons and raise the likelihood of heart attacks.

Main text

In particular, several researchers have found diabetes mellitus-related biochemical pathways that raise the likelihood of cardiovascular disorder in people with diabetes individually. This review describes diabetes-cardiovascular disorder relationships, explores potential therapeutic mechanisms, addresses existing treatment, care, and describes the directions for the future for study.

Conclusion

Thus, in individuals with diabetes, it is important to concentrate on cardiovascular threat variables to reduce the illness’s lasting cardiovascular complications. Further work to enhance knowledge of the disease state and its impact on cardiovascular function is required to boost medical treatment and cardiovascular disorders result in people with diabetes.

Are SGLT-2 Inhibitors the Future of Heart Failure Treatment? The EMPEROR-Preserved and EMPEROR-Reduced Trials

Heart failure is frequently associated with diabetes, and therapies which reduce mortality in people with heart failure and reduced ejection fraction (HFrEF) are often limited to drugs which modulate the renin-angiotensin-aldosterone system or heart rate control and occasionally to device therapy. Treatment is even more challenging in people with heart failure and preserved ejection fraction (HFpEF), with currently no approved therapy demonstrating a mortality-improving effect, limiting treatment to diuretics for the alleviation of the symptoms of fluid overload and risk factor management. Previous cardiovascular outcome trials for sodium-glucose co-transporter-2 (SGLT-2) inhibitors have demonstrated significant favourable outcomes for cardiovascular disease, heart failure hospitalisation and all-cause mortality. The aim of the nearly completed EMPEROR-preserved and EMPEROR-reduced trials is to determine the impact of empagliflozin on cardiovascular and heart failure outcomes in people with HFpEF or HFrEF with or without diabetes. The trials will add substantially to our understanding of SGLT-2 inhibitors in the treatment of HFrEF and may have major implications for the treatment of people with HFpEF. The study will also be powered to address the impact of empagliflozin on changes in renal function in people with and without diabetes and incident diabetes in the participants without diabetes at baseline. In this article we discuss the rationale for using SGLT-2 inhibitors in people with heart failure and explore the potential findings and importance of the ongoing EMPEROR-preserved and EMPEROR-reduced trials.