MUTUAL INFLUENCE OF HEART FAILURE ON THE COURSE OF TYPE 2 DIABETES MELLITUS

Аннотация

Chronic heart failure (CHF) is one of the most significant medical and social pathologies characterized by a high prevalence and mortality. According to experts, CHF in Western countries occurs in 1-2% of the general population, reaching 10% in people over 70 years of age. In the Russian Federation, CHF is diagnosed in 7-10% of cases, while more than 65% of Russian patients are people over 60 years old. In the structure of mortality from diseases of the circulatory system, CHF occupies one of the leading positions 19, 13, 15, 16].Among the reasons leading to the development of CHF, arterial is traditionally considered - hypertension (AH) and coronary heart disease (CHD), which occupy the largest share in the structure of nosologies that cause the formation of heart failure (95.5% and 69.7%, respectively). The classical causes of CHF (heart defects, cardiomyopathies, myocarditis, etc.) are less common. At the same time, one of the frequent and significant diseases characterized by the early development of heart failure is type 2 diabetes mellitus (DM), which has been shown in a number of studies. In the Russian Federation, DM ranks third (15.9%) among the causes of CHF [9, 13, 14]. In addition, the occurrence and progression of heart failure in patients withDM is one ofthemain causes ofdeath in thiscohort ofpatients. Key words: diabetes mellitus, pharmacotherapy, ischemic cardiomyopathy, hypoglycemia, multidisciplinary approach. Pathogeneticrelationshipsbetween CHF andtype2diabetes The above relationships between CHF and DM, in terms of increasing severity and accelerating the progression of pathological manifestations, are explained by pathophysiological relationships that have recently been intensively studied, supplemented by new facts and theories. Previously The negative impact. Of DM on the development of CHF was considered from the standpoint of the atherosclerotic concept, according to which heart failure develops as a result of a multifactorial pathological process associated with changes in lipid metabolism, hyperglycemia, insulin resistance, hypertension, which create conditions for the formation of coronary artery disease, and later CHF. An undoubted contribution to the formation of CHF Is made by developing diabetic cardiomyopathy. In recent years, the above concept has been supplemented by a cardioreno-metabolic approach that considers the pathogenetic links between DM and CHF from the point of view of mechanisms not related to the atherosclerotic process. These include: impaired renal function, systemic inflammation, endothelial dysfunction, activation of the sympathetic nervous system, renin-angiotensin-aldosterone system, etc.. leading to an increase in myocardial stiffness, its hypertrophy, interstitial fibrosis, and ultimately to heart failure [4]. The variety of pathogenetic bases for the development of CHF in patients with DM determines the importance of adequate and justified, from the standpoint of evidence-based medicine, pharmacotherapy. The latter should be considered differentiated depending on the form of heart failure, namely the presence of systolic or diastolicdysfunction of the left ventricle (LV), which are characterized by reduced or preserved (respectively) ejection fraction (EF). In patients with DM, thedevelopment ofthe diastolicform ofCHFPredominates [4,23). Influence oftype2diabetes on prognosisinCHF 54 INTERNATIONAL MULTIDISCIPLINARY JOURNAL FOR RESEARCH & DEVELOPMENT SJIF2019:5.2222020:5.5522021:5.6372022:5.4792023:6.5632024:7,805 eISSN:2394-6334 https://www.ijmrd.in/index.php/imjrd Volume12,issue07(2025) DM 2has a significant adverse effect onthe prognosis inindividuals with various types of CHF. According to major meta-analyses, it is considered in CHF with low LV ejection fraction (EF) as a significant independent risk factor for death. Among in persons with CHF with low LV EF and DM 2, the risk of decompensated heart failure (HF) is approximately 2 times higher than in patients with CHF without diabetes. Individuals with a combination of these two conditions also show a higher rate of repeated admissions to the hospital for CHF, and a lower quality life. SD 2 negatively also affects course of CHF with preserved LV EF, increasing risk development decompensation and mortality. Randomized controlled trials (RCTs) CHARM I and I- PRESERVE [9, 10] have shown that these adverse effects of DM 2 in this variant of CHF may beeven morepronounced than in individuals withCHF with lowLV EF. Pathophysiologicalaspects ofthedevelopment ofCHF inpatients with type 2diabetes In the development of CHF in type 2 diabetes, a key stimulating role is assigned to the changes inherent in diabetes, including insulin resistance, hyperinsulinemia, hyperglycemia, and accumulation of glycosylation end products (AGES) - advanced glycation end - products - AGES [2, 11]. The impact of these factors determines the formation of three main pathophysiological mechanisms: (1) accelerated atherosclerotic