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European Heart Journal Advance Access published online on May 7, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn203
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Sweet hearts die earlier—lessons from CHARM

Michael Kindermann and Michael Böhm*

Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Kirrberger Straße, D-66421 Homburg/Saar, Germany

* Corresponding author. Tel: +49 6841 1623372, Fax: +49 6841 1623369, Email: boehm@med-in.uni-saarland.de

This editorial refers to ‘Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure. An analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme’{dagger} by M.R. MacDonald et al., on page 1377

The first 10% of the full text of this article appears below.

It has been recognized for nearly a quarter of a century that patients with diabetes who develop cardiovascular disease (CVD) suffer from a worse prognosis than do CVD patients without diabetes mellitus.1 Against this background, the news from the CHARM Investigators2 that diabetes is an independent predictor of cardiovascular morbidity and mortality, not only in heart failure patients with severe systolic dysfunction but also in those with preserved ejection fraction, is not a big surprise. Accelerated coronary atherosclerosis,3 abnormal platelet function, coagulation, fibrinolysis, and endothelial dysfunction which favour coronary thrombosis,4 and autonomic neuropathy associated with an increased rate of ventricular arrhythmia and sudden death5 are possible mechanisms which may independently from left ventricular systolic dysfunction contribute to an increased risk of fatal and non-fatal complications in patients with diabetes and CVD.

Hence, the interesting and not easy to explain issue in the study of MacDonald . . . [Full Text of this Article]


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