EPIDEMIOLOGICAL AND PATHOGENETIC ASPECTS OF CHRONIC HEART FAILURE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

• Published in: Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії Vol. 25; no. 2; pp. 300 - 309
• Main Authors: Gorb, Yu.G., Serik, S.A., Tkachenko, O.V., Ryabukha, V.V.
• Format: Journal Article
• Language: English
• Published: 29.05.2025
• ISSN: 2077-1096; 2077-1126; 2077-1126
• DOI: 10.31718/2077-1096.25.2.300

Introduction. Diabetes mellitus remains a pressing global public health concern. The most prevalent form is type 2 diabetes mellitus (T2DM), accounting for 90–95% of all diabetes cases. According to the International Diabetes Federation, approximately 10.5% of the adult population is affected by T2DM, and nearly half of these individuals are unaware of their condition. Each year, an estimated 7 million new cases of T2DM are diagnosed, and its global prevalence continues to rise steadily. Currently, there are 537 million people living with T2DM worldwide, a number projected to increase to 783 million by 2045. Objectives. The aim of this article is to explore the epidemiology, pathogenesis, and interrelationship between chronic heart failure and T2DM, with a detailed analysis of the mechanisms underlying their mutual influence, as well as the risk factors contributing to the development and progression of these conditions. Results. The main pathophysiological mechanisms underlying the development of chronic heart failure in patients with T2DM include hyperglycemia, insulin resistance, elevated levels of advanced glycation end products, lipotoxicity, activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, mitochondrial dysfunction, impaired myocardial energy metabolism, chronic inflammation, endothelial dysfunction, and oxidative stress. Current evidence highlights the critical role of natriuretic peptides in the pathogenesis of chronic heart failure in patients with T2DM, emphasizing their value as diagnostic and prognostic biomarkers that enable the detection of early stages of heart failure and aid in risk stratification for disease progression. Particular attention is given to the pathogenesis of diabetic cardiomyopathy, a distinct myocardial disorder that occurs in patients with T2DM in the absence of coronary artery disease, hypertension, or valvular heart disease. It is one of the most common cardiovascular complications of T2DM and significantly increases the risk of developing CHF while worsening the overall prognosis. Diabetic cardiomyopathy is characterized by pathological cardiac remodeling, including myocardial hypertrophy and fibrosis, which increase myocardial stiffness. This leads to early diastolic dysfunction, followed in more advanced stages by left ventricular systolic dysfunction. Conclusion. An important area of focus is the investigation of the roles of microRNAs and diabetic cardiac autonomic neuropathy in the pathogenesis of diabetic cardiomyopathy, which holds promise for the development of novel diagnostic and therapeutic strategies. The importance of implementing screening tests for the early identification of patients at high risk of progression from diabetic cardiomyopathy to clinically overt chronic heart failure is emphasized. The study also highlights potential avenues for prevention and treatment, aimed at improving outcomes in this vulnerable patient population.