Analysis of therapeutic effect and safety of target-dose metoprolol in the treatment of patients with diabetes mellitus plus chronic heart failure

IntroductionIn this study, the molecular mechanisms underlying the therapeutic effect of metformin (MET) and ivabradine (IBD) in the treatment of concomitant chronic heart failure (CHF) and diabetes mellitus (DM) were investigated.Material and methodsBasic and cardiac indexes were measured to study the therapeutic effect of MET and IBD. Real-time PCR, IHC assays, in-silicon analysis, luciferase assays, real-time PCR and Western blot assays were conducted to clarify the molecular mechanisms underlying the interaction between MET and IBD.ResultsMET administration restored the normal values of general/cardiac indexes in CHF rats. The abnormal values of echocardiographic indexes in CHF rats with STZ-induced DM were all corrected by a certain degree after the MET administration. Moreover, the injection of STZ up-regulated the expression of plasma NE/BNP-45, while the IBD administration reduced the levels of NE/BNP-45 in CHF rats. Furthermore, the administration of MET also reduced the NE level in CHF rats, indicating that both MET and IBD can exert a therapeutic effect on CHF rats. Additionally, in-silicon analysis and luciferase assays verified the role of H19 and HCN4 as target genes of miR-423-5p. In fact, the transfection of MET or H19 siRNA1/2 into HL-1 and H9C2 cells down-regulated the levels of H19 and HCN4 while increasing the level of miR-423-5p.ConclusionsMET reduces H19 expression via inducing methylation of its promoter, and the inhibited H19 expression suppresses HCN4 expression by up-regulating miR-423-5p expression. As a result, the suppressed expression of HCN4 reduces heart rate and exhibits a therapeutic effect in the treatment of concomitant CHF and DM.

Download Full-text

e0610 The Changes of B-type natriuretic peptide in chronic heart failure patients with diabetes mellitus

Heart ◽

10.1136/hrt.2010.208967.610 ◽

2010 ◽

Vol 96 (Suppl 3) ◽

pp. A188-A188

Author(s):

Q. Peng ◽

H. Su ◽

T. Xie ◽

D.-z. Hong ◽

Q.-h. Wu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Chronic Heart Failure ◽

Natriuretic Peptide ◽

Heart Failure Patients ◽

Patients With Diabetes

Download Full-text

Management of Patients with Chronic Heart Failure and Diabetes Mellitus

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-04-05 ◽

2021 ◽

Vol 17 (2) ◽

pp. 341-350

Author(s):

E. V. Reznik ◽

T. L. Nguyen ◽

G. N. Golukhov

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Insulin Resistance ◽

Chronic Heart Failure ◽

Left Ventricular ◽

Metabolic Effects ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Neprilysin Inhibitor ◽

Patients With Diabetes

Chronic heart failure (CHF) occurs in 4.3-28% of patients with diabetes mellitus and is most often associated with the presence of coronary heart disease, arterial hypertension and the direct adverse effects of insulin-resistance, hyperinsulinemia and hyperglycemia on the myocardium. Diabetes mellitus occurs in 12-47% of patients with CHF and can develop within several years after a diagnosis of HF in 22% of patients due to insulin-resistance of failure tissues. The presence of diabetes mellitus leads to a greater severity of clinical symptoms and hospitalization rate, worsening of quality of life and prognosis in CHF. A decreased left ventricular ejection fraction is an independent predictor of the poor prognosis in the patients with diabetes mellitus. The algorithm of the treatment of CHF in the patients with and without diabetes mellitus is not fundamentally different, but it requires taking into account the metabolic effects of the prescribed drugs. Angiotensin receptor-neprilysin inhibitor are increasingly used in clinical practice and are gradually replacing angiotensin-converting enzyme inhibitors and sartans in CHF both without diabetes mellitus and in its presence. Recently, the effectiveness of type 2 sodium glucose cotransporter inhibitors has been proven in patients with CHF with and without diabetes mellitus. This review is devoted to the relationship of diabetes mellitus and CHF, as well as the approaches to the management of such comorbid patients.

Download Full-text

Features of course and treatment of chronic heart failure in patients with diabetes mellitus type 2

Медицина сьогодні і завтра ◽

10.35339/msz.2020.86.01.03 ◽

2020 ◽

Vol 86 (1) ◽

pp. 17-32

Author(s):

Yu.G. Gorb ◽

V.I. Strona ◽

O.V. Tkachenko ◽

V.V. Ryabukha

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Chronic Heart Failure ◽

Diabetes Mellitus Type 2 ◽

Diabetes Mellitus Type ◽

Increased Risk ◽

Close Relationship ◽

Patients With Diabetes ◽

High Degree

The epidemiology of chronic heart failure in patients with diabetes mellitus type 2, their general pathophysiological mechanisms, the influence of diabetes mellitus type 2 on the course and prognosis of chronic heart failure are considered. The high prevalence of chronic heart failure of all phenotypes among patients with diabetes mellitus type 2 and the increased risk of developing diabetes mellitus type 2 in patients with chronic heart failure confirm the close relationship and the high degree of comorbidity between these pathological conditions. It is shown that the development and progression of chronic heart failure in patients with diabetes mellitus type 2 is the formation of diabetic cardiomyopathy, which is characterized by disorders of energy metabolism of cardiomyocytes, mitochondrial dysfunction with subsequent apoptosis and myocardial fibrosis. Important links in the pathogenesis of chronic heart failure in diabetes mellitus type 2 are also the accession of diabetic cardiovascular autonomic neuropathy, activation of the renin-angiotensin-aldosterone system, endothelial dysfunction, exposure to atherogenic factors, arterial hypertension, obesity. The features of treatment of chronic heart failure in patients with diabetes mellitus type 2, the results of randomized clinical studies, the choice of target glycemic levels, the effectiveness of different groups of antihyperglycemic agents, drugs for the treatment of chronic heart failure, as well as their impact on the course and prognosis of chronic heart failure. Keywords: chronic heart failure, diabetes mellitus type 2, course, prognosis, treatment.

Download Full-text