Table 2.
Major studies on treatment strategies of diabetic cardiomyopathy
| Reference | Type of diabetes | Intervention | Purpose | Follow-up period | Treatment regimen | Results |
|---|---|---|---|---|---|---|
| [145] | 2 | Diet/exercise | ↓ incidence of DCM | 6 y | Control (n = 195) vs exercise (n = 211) vs diet + exercise (n = 194) | 33% ↓ in the diet group 47% ↓ in the exercise group 38% ↓ in the diet + exercise |
| [146,147] | 2/IGT | Behavioral diet + physical therapy | ↓ onset of diabetes ↓ DCM incidence |
3.2 y | Individualized counseling vs general oral and written information about diet/exercise | 58% ↓ in the intervention group of diabetes 56% ↓ in the intervention group of DCM |
| [149] | 2, newly diagnosed | Prolonged dietary management | ↓ DCM incidence ↓ of cardiovascular mortality |
10 y | Diet alone (n = 219) vs diet + tolbutamide 500 mg/metformin twice a day (n = 140) vs insulin (n = 73) | 1.04 RR for MI per ↑ 1 mmol/L in fasting plasma glucose, no difference between treatments for the risk of MI |
| [150] | 2, newly diagnosed | Intensified health education | ↓ MI incidence ↓ all-cause mortality |
11 y | a. Usual care (n = 378) vs b. intensified health education (n = 334) vs b + 1.6 clofibric acid/day (n = 332) | 15.2% patients suffered from MI and 19.2% died, postprandial glucose levels were independent risk factors for CVD death |
| [152] | 2 | none | Evaluation of hyperglycemia exposure to the incidence of DCM | 10 y | Not applicable | Each 1% ↓ in HbA1c was associated with: 14% ↓ in risk for MI 16% ↓ in risk for HF |
| [153] | 2 | Simvastatin 20 to 40 mg | Prevention of recurrent CVD in DCM | 5.4 y | Placebo vs simvastatin 20 to 40 mg per day | 55% ↓ in CVD risk |
| [154] | 2 | Gemfibrozil 1,200 mg/day | Changes in plasma lipids could reduce major CVD events | 7 y | Placebo (n = 1.267) vs gemfibrozil 1,200 mg/day (n = 1.264) | 22%↓ of CVD events for every 5 mg/dL ↑ in HDL-C, there was an 11% ↓ in CVD events |
| [155] | 2 | Gemfibrozil 1,200 mg/day | Efficacy of gemfibrozil in varying glucose levels association between hyperglycemia and CVD risk | 7 y | Placebo (n = 1.267) vs gemfibrozil 1,200 mg/day (n = 1.264) | Fasting insulin ≥ 271 pmol/L was associated with: 31% ↑ CVD risk 41% ↓ in CVD death |
| [158] | 2 | Diuretic or Ca-blocker or ACE | Differences in CVD risk between antihypertensive regiments | 4.9 y | Diuretic (chlorthalidone 12.5 to 25 md/d, n = 15.255) or Ca-blocker (amlodipine 2.5 to 10 mg/d, n = 9.048), or ACE inhibitor (lisinopril 10 to 40 mg/d, n = 9.054) | 10.2% ↑ risk of HF with amlodipine 19% ↑ risk of HF with lisinopril 33.3% ↑ risk of DCM with lisinopril, better blood pressure control with chlorthalidone |
| [159] | 2 | Ramipril 10 mg/day | Prevention death from CVD, MI, allcause mortality, HF, DCM, development of diabetes | 5 y | Placebo (n = 4.652) vs ramipril (n = 4.645) | 6.1% ↓ of CVD death 9.9% ↓ of MI 10.4% ↓ of all-cause death 9% ↓ of HF 6.4% ↓ of DCM 3.6% ↓ in new diabetes |
| [160] | 2 | Felodipine 5 mg/day | Achievement of blood pressure targets with the addition of ASA and association to DCM and CVD risk | 3.8 y | Felodipine 5 mg/d + ASA vs felodipine 5 mg/d + placebo | 51% ↓ of CVD risk in target ≤135/80 mm Hg + 15% ↓ of CVD risk with ASA and 36% ↓ in MI |
| [161] | 2 | Losartan 50 to 100 mg/d | ↓ of CVD risk with losartan vs atenolol | 4.7 y | Losartan 50–100 mg/d (n = 586) vs atenolol 50–100 mg/d (n = 609) | 76% ↓ of relative CVD risk |
| [162] | 2 | Blood pressure control <150/80 mm Hg | ↓ of CVD risk | 8.4 y | Captopril (50–100 mg/d, n = 400) vs atenolol (50–100 mg/d, n = 358) | 24% ↓ of CVD risk 32% ↓ of death 56% ↓ of HF |
| [164] | 2 | Irbesartan 300 mg/d vs amlodipine 10 mg/d | ↓ of blood pressure provides protection against progression of nephropathy | 2.6 y | Irbesartan (300 mg/d, n = 579) vs amlodipine (10 mg/d, n = 567) vs placebo | With irbesartan: 37% ↓ risk of doubling serum creatinine 23% ↓ risk of end-stage renal disease 23% ↓ risk of HF |
| [166] | 2 | Clopidogrel 300 mg/d bolus, followed by clopidogrel 75 mg/d for 3–12 mo | ↓ of CVD mortality | 1 y | Clopidogrel 300 mg/d bolus, followed by clopidogrel 75 mg/d for 3–12 mo vs placebo | 15% ↓ of MI rate |
Abbreviations: DCM, diabetic cardiomyopathy; IGT, impaired glucose tolerance; RR, relative risk; MI, myocardial infarction; CVD, cardiovascular disease death; HF, heart failure; HDL-C, high density lipoprotein-cholesterol levels; Ca-blocker, calcium channel blocker; ACE, angiotensin-converting-enzyme; ASA, acetylsalicylic acid.