Heart failure

Early Stage Heart Failure – Part 2

Diabetes is a powerful risk factor for the development of heart failure. (Photo: Pexels)

LAST week we explored the risk of heart failure, hypertension and coronary heart disease. This week, we’ll explore how diabetes, obesity, and other conditions contribute to early-stage heart failure.

Diabetes

Diabetes is a powerful risk factor for the development of heart failure. A Dutch study found that in patients with type 2 diabetes over the age of 60 without a prior diagnosis of heart failure, screening for heart disease produced a new diagnosis of heart failure in 27.7% of patients . Diabetes is not only associated with heart failure, but it also worsens the outcome of patients with heart failure. For diabetic patients, recent research has shown that certain diabetes medications can significantly reduce the development of heart failure. These drugs, SGLT2 inhibitors (Forxiga and Invokana), have been shown to reduce the risk of heart failure hospitalization and cardiac death in diabetic patients with and without a diagnosis of heart failure and should be considered in patients high-risk diabetics. There is also support for reducing heart failure hospitalization in non-diabetic patients when receiving SGLT2 inhibitors.

Obesity

Obesity, especially marked obesity, is associated with the development of heart failure. The 2002 Framingham study found that obesity doubled the risk of heart failure and that each unit increase in body mass index increased the risk of heart failure in men by 5% and women by 7%. Diagnosing heart failure in obese people can be quite difficult because the symptoms of shortness of breath and swelling may be related to obesity or obesity-associated lung disease. Also, heart tests can be difficult in very obese people. Reducing the risk of heart failure in this population is an area of ​​active research, with some studies suggesting that bariatric surgery may be helpful in reducing the risk of heart failure and improving outcomes if heart failure is already present. In one study, six out of 10 women and four out of 10 men in Jamaica were either overweight or obese.

Other terms

There are other conditions that put the patient at high risk for heart failure and are considered stage A. These include exposure to cardiotoxic agents, eg, chemotherapy for cancer treatment, radiotherapy thoracic, drug addiction, etc. Patients with a strong family history of cardiomyopathy and genetic changes that increase the risk of cardiomyopathy are included in this group. A particular gene, V142I, has been shown to be associated with a particular type of cardiomyopathy called cardiac amyloidosis. This gene is found in three to five percent of populations of African descent, including many in Jamaica. A study of Afro-Caribbeans in the UK found that this condition was responsible for 15% of heart failure cases in this population. Patients with cardiac amyloidosis can develop heart failure which can be difficult to treat. We are starting to see more patients with this disease in Jamaica.

How can we improve outcomes for patients with stage A heart failure?

An important part of preventing symptomatic heart failure has to do with how we live our lives. We need to exercise regularly, eat a heart-healthy diet, avoid smoking, limit alcohol intake, and try to maintain a normal weight. As physicians, we must recognize patients at risk for heart failure and manage conditions to reduce their future risk. Research is currently investigating screening these patients with blood tests to measure cardiac filling pressures, imaging studies of the heart and early cardiac consultation may prevent or delay progression to more advanced heart disease and initial results are encouraging. We will soon be initiating a study at HIC in collaboration with colleagues from Yale University and University Hospital of the West Indies to investigate the problem of cardiac amyloidosis in Jamaica.

Certainly, for patients at stage A or at increased risk of heart failure, there should be early and aggressive management to improve future outcomes.

Dr. Ernest Madu, MD, FACC and Dr. Paul Edwards, MD, FACC are Consultant Cardiologists for the Caribbean Heart Institute (HIC) and HIC Heart Hospital. HIC is the regional center of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered with the Department of Health and Welfare and is Jamaica’s only heart hospital. Correspondence to [email protected] or call 876-906-2107