The Intersection of Diabetes and Heart Diseases: Advances in Science and Management

Dear Colleagues,

Despite advances in diabetes management and heart attacks, heart disease remains a major cause of morbidity and mortality in type 2 diabetes, accounting for 10-11% of all vascular deaths and a 2-3-fold higher risk of heart disease in subjects with diabetes. A few ethnic populations, such as South Asians, seem to have a higher prevalence of diabetes and heart disease, with these occurring 10-20 years earlier. Blacks, Hispanics, and women also have a higher prevalence of heart failure with diabetes.

Altered dietary habits along with a lack of physical activity, a high waist-to-hip ratio, sarcopenia and inflammation contribute to a higher risk of comorbidity. In addition, food quality and food insecurity significantly elevate the risk of heart failure and diabetes, along with social determinants of health (SDOHs). Besides the established mechanistic basis of endothelial dysfunction, increased coagulability, altered platelet function and abnormal lipids, newer mechanistic etiologies have been proposed, including maladaptive trained immunity, metabolic perturbations of intermittent hypoglycemia, a time in range of A1C with continuous glucose monitoring and fluctuations in blood sugar associated with cardiovascular events, Forkhead transcription factors ( FOX genes) in epigenetic environment, altered remnant lipoproteins, APO C III, oxidative stress, mitochondrial dysfunction, calcium overload, activation of Protein Kinase pathways, myocardial lipomatosis, micro-RNAs, Interleukins and other markers of inflammation.

From a clinical trial standpoint, improvement in glycemic control has not been demonstrated to reduce cardiovascular events. More recently, newer therapies with SGLT2 inhibitors and GLP1 receptor agonists have shown an improvement in CV events including heart failure and preventing the progression of kidney disease. Newer therapies, including FGF 21, and others are being studied in subjects with NASH/NAFLD and in managing hypertension in diabetes subjects.

An improved understanding of the natural history of atherosclerosis in diabetes and its risk factors during the earlier phases of metabolic syndrome may lead to more innovative cardioprevention therapies. An aggressive approach incorporating the “Food as Medicine” concept needs to be developed in pragmatic stepped-wedge design trials. Heart failure with preserved ejection fraction present another challenge whose treatment necessitates more trials beyond the initial benefit noted with SGLT2 inhibitors. New therapy targets are being explored in early clinical trials. Muscle-strengthening activities employing various devices and technologies needs to be incorporated and researched for the treatment of sarcopenia. For this Special Issue, we invite authors to enlighten our readership with robust manuscripts focused on the above topics .We hope that the manuscripts presented in this Special Issue will satisfy our goal of encouraging further research from informed, committed healthcare professionals to solve the most pressing problems in diabetes and heart disease. We hope that the insightful findings presented in this Special Issue will debunk some of the myths surrounding this topic and inspire our readership with the knowledge gained in pursuit of a healthier, more equitable world.

Dr. Krishnaswami Vijayaraghavan
Guest Editor

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• type 2 diabetes
• heart failure
• hypertension
• heart disease