특집 : 당뇨병과 심부전

Heart failure in patients with diabetes has long been considered a consequence of coronary artery disease. However, recent epidemiological evidence from patients with diabetes has shown a significantly increased prevalence of heart failure in patients without significant coronary artery stenosis, suggesting a separate entity involving diabetic complications. Therefore, heart failure in patients with diabetes is now considered as an independent disease entity, ‘diabetic heart’. The mechanism of ‘diabetic heart’ could be coronary artery disease and diabetic cardiomyopathy caused by advanced glycation end products and altered calcium handling, as well as changes to energy metabolism and oxidative stress in the myocardium of patients with diabetes. Recent cardiovascular outcome trials of anti-diabetic medications demonstrated the protective effects of certain drugs against heart failure in patients with and without diabetes. This review summarizes the relationship between diabetes and heart failure, and informs treatment planning for the prevention of heart failure in diabetic patients.