Is Diabetes a Real Risk Factor for Heart Failure?

Diabetes is frequently associated with atherosclerosis and myocardial infarction ("heart attack"), but beyond these, it is also a significant risk factor for developing heart failure.

Data show that about one-third of hospitalizations due to heart failure involve patients diagnosed with diabetes, and approximately 22% of people with diabetes over the age of 65 develop heart failure. The connection between these diseases is under continuous study and is likely due to various processes, including vascular dysfunction, but also direct damage to the heart muscle from diabetes itself.

One prevailing hypothesis is that diabetes causes direct harm to heart muscle tissue, as indicated by several studies and ongoing research by scientists worldwide. Research has found that people with diabetes have a 2.1 times higher risk of developing heart failure compared to the nondiabetic population, and even among those with high cholesterol or other cardiovascular complications that damage blood vessels, diabetics face a 2.5 times higher risk.

In Israel, according to a study conducted in 2018, nearly half (about 46%) of hospitalized patients following cardiac events were diagnosed with diabetes, and about 13% were diagnosed with heart failure. An international survey on the subject also found that diabetic men face twice the risk of heart failure as healthy men, while diabetic women have a fivefold risk compared to their healthy counterparts of the same age.

Existing literature suggests that the link between diabetes and heart failure is actually insulin resistance and the impairment of various proteins due to prolonged exposure to high blood sugar levels. Insulin resistance leads to metabolic changes in heart muscle cells and increases the use of alternative fuels as an energy source for these cells—resulting in toxicity, oxidative damage, and inflammation that harms heart cells. Furthermore, high sugar levels and decreased use of sugar as an energy source can harm the genetic material of heart cells and contribute to heart muscle damage.

The damage to heart muscle function may manifest as a decrease in the muscle’s contraction strength or, alternately, in reduced relaxation capability, potentially leading to increased pressure in the heart chambers.

To reduce risks of diabetes complications—including heart and blood vessel diseases—it's crucial to maintain balanced blood sugar levels as much as possible. This can be aided by using a continuous glucose monitor that allows 24/7 tracking of blood sugar. Additionally, adhering to an appropriate diet and maintaining a healthy weight, balancing risk factors like high blood pressure, avoiding smoking, engaging in regular physical activity, and ongoing consultations with a diabetes specialist are important.

Beyond this, monitoring cardiac function through clinical evaluations, ECGs, and additional tests as needed is advised.

Dr. Ofer Habkuk is an expert in cardiology and heart failure at the DMC Center for Diabetes Care