Dr Javed Butler: Recognizing Risk of Heart Failure in Patients With Diabetes Key to Preventive Care

Improving recognition of the link between heart failure and diabetes can promote preventive care for at-risk patients, said Javed Butler, MD, MPH, MBA, professor of physiology and chairman for the Department of Medicine at the University of Mississippi.

Transcript

A study in JAMA Cardiology found that deaths from heart failure are increasing. What factors are contributing to this increase?

There are multiple reasons for that. So, just in general, even without diabetes, the population is getting older. So, there are more people who are developing heart failure at later stages of life and that may be perhaps 1 factor. The bigger issue is that in the past, there were a lot of people [who] died because of a heart attack or because of valvular disease, aortic stenosis. Now, we have effective therapies whereby we delay their ultimate demise. However, those patients now live with a heart which is not totally normal, and they develop heart failure as well. So, that is the second reason, but the bigger issue is that more and more people are developing multiple risk factors and multiple comorbidities together.

So, there is more and more people living with high blood pressure, diabetes, aging, chronic kidney disease, and these multi-morbid conditions all together increases the risk of patients dying as well; but the last thing, and that is a reason because of which we are doing this initiative Diabetes Can Break Your Heart as well, is the recognition. So, I think we worry about heart attacks, very appropriately so, but we worry about heart attack, stroke in patients with diabetes or peripheral vascular disease a lot more than heart failure. So, our preventive strategies, our diagnostic strategies, and how aggressively we treat them—there are some gaps there and that can also lead to increased risk of dying. Hopefully with initiatives like this, we can bend the curve.

Can you discuss why preventing heart failure is so important, especially among those who have been diagnosed with diabetes? What are the components of preventing heart failure?

Prevention of heart failure is very important. First, let me reiterate that patients with diabetes when they develop heart failure, even without diabetes, patients with heart failure are at a very high risk; but if you combine the 2, diabetes and heart failure, the risk is really exaggerated. So, if you have somebody with heart failure and diabetes, we need to get very aggressive in treating those patients. Having said that, wouldn't it be nice if you can just prevent that in the first place. So, rather than trying to improve the patient's condition after something bad has happened, why not we try to prevent that in the first place.

It is not only a theoretical concern, we actually have opportunities—we have ways and means by which we can reduce the risk of developing heart failure. So, 1: it is a very common complication; 2: it's a lethal complication; 3: we can actually do something about it. So, if you look at the bigger picture, it becomes sort of an imperative for us and healthcare to identify patients at high risk and then do whatever we need to do to prevent development of heart failure, and there's a lot that we can do.

So, there are data—for instance, healthy Living in these high risk patients. So, decrease salt intake, exercise, weight control. Probably 1 of the strongest ways by which 1 can reduce the risk of heart failure and prevent heart failure is if they are overweight and they can lose weight. High blood pressure–patients with diabetes very commonly have high blood pressure, and good blood pressure control can literally cut the risk of heart failure by half–really can impact. Stop cigarette smoking, cholesterol treatment, and now there are specific therapies for diabetes that if you give patients with diabetes, you can substantially prevent the risk of heart failure. So, it's not just 1 thing, there's a plethora of things that we can do and reduce the risk for developing heart failure.