Skill Checkup: A 65-Year-Old Woman With Treated Type 2 Diabetes Presents With Shortness of Breath and Lightheadedness

Romesh Khardori, MD, PhD


February 23, 2023

This patient has a 10-year history of T2D and poorly controlled hypertension, LDL-C, and hyperglycemia. Overall, patients who have T2D and one or more poorly controlled cardiovascular risk factors (HbA1C, blood pressure, lipids, and kidney function) have an elevated risk of developing HF (hazard ratio [HR], 1.45; 95% CI, 1.34-1.57) vs controls. T2D itself is considered a risk factor for HF; in fact, the American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) guidelines place patients with T2D but without symptoms of HF in the at-risk category (stage A). In addition, common comorbid conditions of T2D, like CVD and obesity, are also risk factors for HF.

Evidence suggests that T2D contributes to HFrEF by undermining cardiomyocyte survival and promoting cardiomyocyte stress and dysfunction. T2D-related effects on renal function also increase plasma volume expansion and left ventricular (LV) filling pressures owing to overabsorption of sodium, placing additional stress on LV function.


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