Scientists discover major cause of diabetics’ elevated risk of heart failure and are working on treatments to tackle it

A new treatment that could help prevent thousands of cases of heart failure in people with diabetes may be available in the UK within five years following a medical breakthrough.

There are 3.9 million people in the UK with type 1 and type 2 diabetes, and those with the condition are 65 cent more likely to develop heart failure than those without, but the reasons for this increased risk have been only partially understood until now.

Scientists have recently discovered that the high blood sugar levels in diabetics can seriously damage the gel-like lining of the small blood vessels in the heart, which is thought to cause more cases of heart failure in people with the condition.

The researchers found the damage to the lining of the small blood vessels increased fluid movement into the walls of the heart, leading to swelling and increased stiffness of the heart muscle.

This prevented the heart from properly relaxing between beats, meaning the heart could not pump blood around the body effectively.

And they have found that mending that damage reduces the risk of heart failure in mice.

Furthermore, tests on human cells in the lab of potential treatments to mend the damage – and prevent it – indicate the treatment will be effective.

The researchers are now testing potential treatments in mice and, if all goes well, hope to begin trials on living humans within two years.

The study is published in the journal Diabetologia and also involved Manchester Metropolitan University, Nottingham University, Bristol Royal Infirmary and North Shore Hospital in Auckland, New Zealand.

“Therapies in this area, that protect blood vessels, have the potential for a huge impact,” Simon Satchell, professor of blood vessel and kidney medicine at Bristol University, told i.

“Every organ, every cell in the body, needs a blood vessel near it, to deliver nutrients and take away waste products. So therapies that protect or improve the function of blood vessels have massive potential,” he said.

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“Some of the big advances in medicine recently, particularly in cardiovascular disease, have been with drugs that protect drug vessels, with statins being the most obvious example,” Professor Satchell added.

Statins are principally concerned with larger blood vessels, helping to mend the inner lining of arteries by reducing cholesterol – whereas this potential new class of drugs would focus on small blood vessels.

In a best-case scenario, researchers hope a new kind of treatment for high-risk diabetics could be available within three to five years – with the speed of deployment depending, in part, on whether they can repurpose existing drugs such as ACE inhibitors used to reduce blood pressure.

Further down the line, the treatments being developed could also potentially be used or adapted to reduce the risk of kidney failure and potentially even blindness in diabetics, as damage to the kidneys and eyes of diabetes is sometimes caused by the same issue with the surface of the small blood vessels.

They may also one day be able to prevent some cases of sepsis – an extreme reaction to a lung, urinary tract, skin or other infection – for people with and without diabetes.

But the researchers caution it could take longer than hoped and with no guarantee of success.

Professor James Leiper, associate medical director at the British Heart Foundation, which funded the study, said: “This research increases our understanding of the biology underpinning diabetic heart failure. If these exciting findings from animals can be reproduced in humans, they may identify potential new treatments for patients with diabetic heart failure.”

Experts not involved in the study also welcomed its findings. Sian Harding, professor of cardiac pharmacology, at Imperial College London, said: “This research opens up promising new avenues for treatment of coronary microvascular dysfunction [damage to the small blood vessels in the heart] which is key to the development of diabetic heart disease, but is also involved in problems with other organs in diabetes, and with other types of cardiovascular disease. The findings could therefore be of wider benefit in future.”

Dr Richard Cubbon, University of Leeds academic fellow, and honorary consultant cardiologist, said: “This study shows for the first time that the protective coating which lines heart blood vessels is damaged by diabetes, that this damage might lead to early features of heart failure and that restoring this coating was linked to improved heart function.”

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