Editorial: Heart Failure in Type 2 Diabetes – The “Forgotten” Complication

Diabetes, particularly type 2 diabetes (T2DM), was recognized as the new “worldwide pandemic” of the 21 st century, with an estimated 8.8% of the adult population (~425 million subjects) afflicted by this condition in 2017 [1]. In the same time, diabetes represents a massive public health issue, being one of the major causes of morbidity and mortality in the modern societies, with high social and economic costs. It is estimated that chronic diseases (including diabetes) have surpassed infectious diseases as the first cause of premature mortality worldwide [2]. In addition, healthcare expenditure related to diabetes in USA reached a staggering 322-377 billion USD [1,2], with a worldwide estimate of 727 billion USD in 2017 according to the latest IDF data [1]. It was long time established that cardiovascular disease (CVD) represents the first cause of death and probably the main cause of disability in subjects with T2DM, with some estimates indicating an 80% excess mortality due to CVD in T2DM [3]. Progresses in the treatment of T2DM and associated CVD risk factors (especially hypertension and dyslipidemia) have led to a continuous decline in the CVD associated morbidity and mortality in diabetes subjects [4,5]. Still, a recent analysis of data from the Swedish National Diabetes Register have shown that T2DM subjects continue to have a 2-4 fold increased risk of death from any cause, death from CVD and death from coronary heart disease (CHD) compared with non-diabetic subjects [4]. This could be explained by the fact that frequently T2DM subjects have asymptomatic / unrecognized CVD, including silent myocardial ischemia and heart failure (HF).