Author + information
- Received October 22, 2018
- Revision received November 9, 2018
- Accepted November 13, 2018
- Published online February 4, 2019.
- Kelly McHugh, BAa,
- Adam D. DeVore, MD, MHSa,b,
- Jingjing Wu, MSb,
- Roland A. Matsouaka, PhDb,
- Gregg C. Fonarow, MDc,
- Paul A. Heidenreich, MDd,e,
- Clyde W. Yancy, MD, MScf,
- Jennifer B. Green, MDg,h,
- Natasha Altman, MDi and
- Adrian F. Hernandez, MD, MHSa,b,∗ (, )@texhern
- aDepartment of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- bDepartment of Medicine, Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
- cDepartment of Medicine, Division of Cardiology, Ahmanson–UCLA Cardiomyopathy Center, Ronald Reagan–UCLA Medical Center, Los Angeles, California
- dVeterans Affairs Palo Alto Health Care System, Palo Alto, California
- eDepartment of Medicine, Division of Cardiology, Stanford University, Stanford, California
- fDepartment of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
- gDepartment of Medicine, Division of Endocrinology, Duke University School of Medicine, Durham, North Carolina
- hDepartment of Medicine, Division of Endocrinology, Duke Clinical Research Institute, Durham, North Carolina
- iDepartment of Medicine, Division of Cardiology, University of Colorado-Denver, Aurora, Colorado
- ↵∗Address for correspondence:
Dr. Adrian F. Hernandez, 200 Trent Drive, Davison Building, Suite 120, P.O. Box 17969, Duke University School of Medicine, Durham, North Carolina 27710.
Heart failure with preserved ejection fraction (HFpEF) is now the most common form of HF, affecting over 3 million adults in the United States alone. HFpEF is a heterogenous syndrome. One important phenotype may be related to comorbid conditions, including diabetes mellitus (DM). DM has a prevalence of approximately 45% in HFpEF, but characteristics and outcomes of this population are poorly understood. In this review, the authors summarize data from several clinical trials of HFpEF therapeutics and provide original data from a large cohort using the Get With The Guidelines-HF registry, which together suggest that DM is associated with increased morbidity and long-term mortality in HFpEF. The authors then discuss several common pathological mechanisms in HFpEF and DM, including sodium retention, metabolic derangements, impaired skeletal muscle function, and potential therapeutic targets. As the understanding of comorbid HFpEF and DM improves, it is hoped clinicians will be better equipped to offer effective, patient-centered treatments.
This work was supported by American Heart Association grant #16SFRN30180010 to Dr. Hernandez. The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Dr. DeVore has received research support from Akros Medical, the American Heart Association, Amgen, Bayer, Intra-Cellular Therapies, Luitpold Pharmaceuticals, the National Heart, Lung, and Blood Institute, Novartis, and the Patient-Centered Outcomes Research Institute; and has served as a consultant for Novartis. Dr. Wu is an employee of Cytel. Dr. Fonarow has received research support from the National Institutes of Health; and has served as a consultant for Amgen, Abbott, Janssen, Medtronic, Novartis, and St. Jude Medical. Dr. Yancy serves as chair of the American Heart Association GWTG-Heart Failure Subcommittee. Dr. Green has received research support from AstraZeneca/Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Sanofi, and Intarcia Therapeutics; and has served as a consultant for AstraZeneca, Merck Sharp & Dohme, Daiichi-Sankyo Company, Boehringer Ingelheim Pharmaceuticals, Sanofi/Regeneron, and Novo Nordisk. Dr. Altman has received research support from the American Heart Association. Dr. Hernandez has received research support from AstraZeneca, GlaxoSmithKline, Luitpold, Merck, and Novartis; and has served as a consultant to Bayer, Boston Scientific, Merck, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received October 22, 2018.
- Revision received November 9, 2018.
- Accepted November 13, 2018.
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