2/3 of the 16 million diabetic patients in the United States ( 6% of the population) will die of some form of heart or blood vessel diseases
1/3 of these patients will remain undiagnosed.
Although major medical advances have improved overall cardiovascular mortality rates, diabetic patients have ? yet to experience the same degree of risk reductions as their nondiabetic counterparts.

Heart failure
--A clinical syndrome with signs and symptoms of congestion and circulatory failure (regardless of cardiac function).
Final common pathway of most end-stage cardiovascular complications.

Cardiomyopathy
--functional pathology of heart muscle
--regardless of symptoms,
--often related to abnormalities in contraction (systolic dysfunction) or relaxation (diastolic dysfunction).

IMPACT OF CARDIOMYOPATHY and HEART FAILURE IN DIABETES
Diabetes is observed in 15% to 25% of HF patients in major clinical trials.
Among all patients hospitalized for heart failure, 25% to 30% patient have DM as a comorbid condition
In large-scale mortality trials, in HF patients with systolic dysfunction, diabetes was an independent risk factor for death.

Framingham Study and  SOLVD
Framingham Study
A direct association between DM and HF was first demonstrated
Risk of developing symptomatic HF
2.4-fold in diabetic men
5-fold in diabetic women,
independent of coexisting hypertension or ischemic heart disease.

Studies of Left Ventricular Dysfunction (SOLVD)
Registry of 6791 patients with heart failure,
1310 diabetic patients were more likely to be hospitalized for HF exacerbation and likely to die.

Cardiomyopathy and Diabetes
A distinctive entity of diabetic CM does exist as a vulnerable alteration to the myocardium
impaired glycemic control
insulin resistance
But direct, concrete evidence is lacking

Similar pathophysiologic processes
Endothelial dysfunction
Oxidative stress
Lead to overt HF that is difficult to treat.
coexisting risk factors
hypertension
dyslipidemia
major index events (such as myocardial infarction)...

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