Heart failure in diabetic patients: utility of beta-blockade.

Background: Congestive heart failure (CHF) occurs with increased frequency in patients with diabetes and carries a higher risk of morbidity and mortality compared with nondiabetic persons. Diabetic patients are more likely to suffer from CHF and its consequences because of hypertensive and ischemic heart disease and diabetic cardiomyopathy.

Methods: Intensive combination therapy, directed at the different aspects of the pathophysiology of CHF in diabetes patients, results in improved outcomes. Improvement of glycemia, reduction of low-density lipoprotein cholesterol levels, tight control of blood pressure, and antiplatelet therapy have been all shown to decrease the morbidity and mortality associated with CHF in diabetic patients. beta-blockade added to angiotensin-converting enzyme (ACE) inhibition has become an increasingly integral component of CHF therapy.

Results: Improved outcome with beta-blockade treatment is due to decreased incidence of both sudden death and pump failure and is of particular benefit to diabetic patients during and after myocardial infarctions complicated by systolic dysfunction.

Conclusions: Based on retrospective analysis, beta-blocking agents with vasodilating properties may provide additional benefits in diabetic patients because they may improve insulin sensitivity and vasorelaxation.