Congestive heart failure and diabetes mellitus: an intricated relationship

peer reviewedThe present article analyses the intimate relationship between diabetes mellitus and congestive heart failure. This relationship is indeed "bidirectional". On the one hand, it is well known that diabetes mellitus, especially type 2 diabetes, predisposes to congestive heart failure due to intricated mechanisms. In most cases, there is a combination of various well-known risk factors, such as obesity, arterial hypertension and coronary heart disease, with a specific diabetic cardiomyopathy, whose pathophysiology is complex. On the other hand, several studies showed that congestive heart failure increases the risk of new type 2 diabetes, probably due to decreased muscular perfusion and excessive neurohumoral response. Remarkably, such a risk could be reduced by a drug capable of inhibiting the renin-angiotensin system, as previously reported in patients with arterial hypertension. The recent launch and the increasing use of thiazolidinediones (glitazones) raise the interest for congestive heart failure in diabetic patients. Indeed, because of their positive effect on insulin resistance and various pleiotropic effects, glitazones may exert some cardiovascular protection; however, both rosiglitazone and pioglitazone are associated with fluid retention, which could reveal or aggravate episodes of congestive heart failure