Diabetes, Obesity, and Heart Failure: The New Pandemic

Introduction

It is important to embrace the fact that diabetes and cardiovascular disease are intimately linked.¹ Indeed, it is not inappropriate to describe diabetes as a “vascular perturbation.” Specifically, endothelial dysfunction with vasomotor instability and atherosclerosis is a hallmark of diabetes mellitus. Only recently has the overlap between diabetes and cardiology been emphasized, with epidemiologic studies identifying the increased risk of cardiovascular morbidity with underlying diabetes mellitus. This is unfortunate since there is an epidemic of diabetes and obesity in North America and the rest of the world (thus, a pandemic) that has prompted concern about a sudden rise of cardiovascular deaths in the United States after a decline of about 40% in the last decade.² Particularly problematic is the relationship of the metabolic syndrome and diabetes to obesity and myocardial dysfunction leading to heart failure, which is known to have extraordinarily high morbidity itself. Is then diabetes, obesity, and heart failure the new cardiovascular pandemic that should demand more attention with the creation of a new field of “cardiologic diabetology” or “diabetic cardiology”?