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From Diabetes Mellitus to Heart Failure
The concept that DM can cause or precipitate HF has been generated even from the Framingham study who estimated that men and women with DM have a two and four times, respectively, increased risk to develop HF compared with non-DM subjects.[9] Epidemiological studies have confirmed this relationship and revealed that impaired glucose tolerance, increased serum glucose levels and glycated haemoglobin levels are associated not only with incidence of systolic HF but also with the prevalence of diastolic dysfunction (see Table 1). Accordingly, guidelines have accepted DM and metabolic syndrome as risk factors for HF,[17] and the term diabetic cardiomyopathy was used to define either systolic or diastolic left ventricular dysfunction in otherwise healthy diabetic persons in the absence of clinically significant coronary, valvular or hypertensive disease.[18] Thus, patients with DM can be categorised in the stage A of the American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) classification of HF, meaning that diabetic subjects are at high-risk for HF but without structural heart disease or symptoms of HF. Therapeutic interventions aim to modify risk factors and guidelines draw attention to monitor and treat DM as early as possible.[17]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159396/