Diabetes is a powerful risk factor for the development of CHF, a major cause of morbidity and mortality in diabetic patients. A multifactorial cardiomyopathy occurs in patients with diabetes that is usually asymptomatic by itself. However, the cardiomyopathy seems to interact with and potentiate coexistent causes of hypertrophy and CHF, especially hypertension and ischemia resulting from coronary artery disease. Management of CHF in diabetic patients is quite similar to management in nondiabetic patients, with a few important differences. ACE inhibitors are very likely even more valuable in diabetic than in nondiabetic patients. Insulin-sensitizing drugs are promising but must be used very cautiously in the presence of heart failure.

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