CareView 3D: conceptualizing heart failure in patients with diabetes

Seth Martin, MD, talks through how clinicians should conceptualize heart failure in patients with diabetes.

Transcript

00:00

We should conceptualize heart failure in patients with diabetes in at least a couple of ways.

00:09

There's the traditional pathway, where someone with diabetes can have your standard, run of the mill coronary heart disease.

00:17

Certainly one of the most common things we take care of is atherosclerotic related disease, and diabetes is a major risk factor

00:23

for atherosclerotic disease. So patients with heart failure could have ischemic heart failure that's driven by diabetes in tandem with elevated cholesterol

00:31

or an atherogenic dyslipidemia along with other risk factors. So that's one way we should be conceptualizing heart failure.

00:38

Another way that we should be conceptualizing heart failure is as direct effects of diabetes on the myocardium.

00:45

Insulin resistance and impaired fatty acid oxidation drive toxic lipid accumulation within cardiomyocytes,

00:52

disrupting mitochondrial function and triggering fibrotic remodeling. Advanced glycation end products stiffen

00:59

the collagen scaffold while activated fibroblasts expand the interstitial matrix, impairing diastolic function

01:07

and increasing chamber stiffness. These changes often manifest as HFpEF before overt coronary disease appears,

01:15

underscoring the need for cardiometabolic rather than purely ischemic framework.