Heart Failure and Diabetes: Understanding the Risks

Diabetes is often associated with atherosclerosis and myocardial infarction, or heart attack, but it is also a significant risk factor for developing heart failure.

Diabetes and Heart Failure Risk

Data show that about one third of hospitalizations due to heart failure involve patients diagnosed with diabetes. Approximately 22 percent of people with diabetes over the age of 65 develop heart failure. The connection between these diseases is under continuous study and likely involves multiple processes, including vascular dysfunction as well as direct damage to the heart muscle from diabetes itself.

Direct Damage to Heart Muscle

One prevailing hypothesis is that diabetes causes direct harm to heart muscle tissue, supported by several studies and ongoing research worldwide. People with diabetes have a 2.1 times higher risk of developing heart failure compared to the nondiabetic population. Even among those with high cholesterol or other cardiovascular complications, diabetics face a 2.5 times higher risk.

In Israel, a 2018 study found that nearly half of hospitalized patients following cardiac events were diagnosed with diabetes, and about 13 percent were diagnosed with heart failure. International research also indicates that diabetic men face twice the risk of heart failure as healthy men, while diabetic women have a fivefold risk compared to healthy women of the same age.

Why Diabetes Affects the Heart

Research suggests that the link between diabetes and heart failure involves insulin resistance and the impairment of various proteins due to prolonged exposure to high blood sugar levels. Insulin resistance causes metabolic changes in heart muscle cells and increases the use of alternative fuels as an energy source, leading to toxicity, oxidative damage, and inflammation that harm heart cells. High sugar levels and reduced use of sugar as an energy source can also damage the genetic material of heart cells, contributing further to heart muscle injury.

Impact on Heart Function

Damage to heart muscle function may appear as a decrease in contraction strength or reduced relaxation capability, potentially increasing pressure in the heart chambers.

Preventing Complications

To reduce the risks of diabetes complications, including heart and vascular diseases, it is crucial to maintain balanced blood sugar levels. This can be supported by using a continuous glucose monitor for around the clock tracking. Following an appropriate diet, maintaining a healthy weight, managing risk factors such as high blood pressure, avoiding smoking, engaging in regular physical activity, and consulting with a diabetes specialist are also important.

Monitoring cardiac function through regular clinical evaluations, ECGs, and additional tests as needed is advised.

Dr. Ofer Havakuk is an expert in cardiology and heart failure at the DMC Center for Diabetes Care