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given that it requires &#8220;simply&#8221; confirming that the patient meets a number of criteria&#44; the diagnosis of HF in daily clinical practice usually entails significant difficulties&#46; The most common symptom of HF is dyspnea&#46; However&#44; &#8220;shortness of breath&#8221;&#44; as our patients would call it&#44; can be due to numerous conditions&#44; such as physical withdrawal&#44; bronchopulmonary disease&#44; obesity and other comorbidities in addition to HF&#46; In addition&#44; several of these conditions often coexist in patients with diastolic HF&#46; Biochemical markers&#44; which include B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide&#44; have high sensitivity but very low specificity&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Once again&#44; patients with diastolic HF frequently have high levels of these markers due to extracardiac disorders&#44; making the use of the markers difficult&#44; in contrast to the situation with&#44; for example&#44; young patients with dilated cardiomyopathy and no other disease&#46; Lastly&#44; unlike systolic HF in which there is one parameter &#40;left ventricular ejection fraction&#41; that helps define the presence of the disease &#40;despite the parameter&#8217;s limitations&#41;&#44; &#8220;structural abnormalities&#8221; that require the diagnosis of HF with preserved ejection fraction &#40;HFpEF&#41; are a poorly defined and heterogeneous group that complicate the diagnosis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">With all these data&#44; it is easy to see that the diagnosis of HFpEF is a real challenge&#46; Nevertheless&#44; this is not the only difficulty&#58; the few clinical trials that have addressed the treatment of this disease have failed to demonstrate some benefit for the evaluated drugs&#46; This lack of success might be due to the fact that numerous disorders are included within the diagnosis of HFpEF&#46; The option of grouping into clusters those patients who share this syndrome could be the first approach to achieve therapeutic success&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">DM2 is one of the most present comorbidities in HF and one that most affects the prognosis of HF&#46; As highlighted by the authors&#44; DM2 can be found in almost half of those with HF and increases the risk of morbidity and mortality in patients with HFpEF&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These data on the prognoses of patients with diabetes and established HF come from large trials on HF&#44; such as the Survival and Ventricular Enlargement &#40;SAVE&#41; trial&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the Valsartan in Acute Myocardial Infarction &#40;VALIANT&#41; trial<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and the Candesartan in HF &#40;CHARM&#41; trial&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> All of these trials showed a greater mortality risk in men and women with diabetes&#46; For example&#44; the CHARM study showed that both men and women with diabetes presented a greater risk of cardiovascular death and hospitalization for HF compared with patients without diabetes&#44; with a cumulative incidence of approximately 40&#37; for 3 years&#46; This high prevalence and association of the 2 entities can be observed in the opposite direction&#44; and HF can be said to be an important contributor to cardiovascular morbidity and mortality in patients with diabetes&#44; with myocardial dysfunction even being present in the absence of epicardial coronary artery disease&#46; In fact&#44; the term &#8220;diabetic cardiomyopathy&#8221;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> has been coined to group these patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">HF is the final expression of numerous diseases that entail cardiac function impairment&#44; many of which do not have a common pathophysiological nexus&#44; as is the case with chronic obstructive pulmonary disease and DM2 itself&#44; both of which are present in the genesis of HF in many patients&#46; We therefore need to make an effort in the diagnosis and treatment of patients with HF&#44; given the heterogeneity of the patients and the diseases that lead to HF&#46; We also need to make adjusting the treatment to the comorbidities a priority in the approach strategy for HF&#46; The classification of patients with HF according to the underlying diseases and the pathophysiological profiles comes from the need to improve the care for these patients&#46; Classifying patients to improve their management is a logical step&#44; which is why subgroups and profiles within HF have been created to improve the management&#46; For example&#44; Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> proposed a classification of patients according to various profiles&#44; including those that go beyond specific diseases&#44; by proposing groups by pathophysiological mechanisms underlying HF &#40;e&#46;g&#46;&#44; according to endothelial dysfunction and inflammation&#41;&#44; all of which is aimed at adjusting the treatment of the mechanisms that lead to a loss of cardiac function&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study by Ar&#233;valo Lorido et al&#46; proposes a classification of patients with HFpEF into profiles whose nexus is DM2&#46; Implementing these profiles of patients with DM2 offers a better approach for these patients and provides a major opportunity to improve the treatment of HF&#44; given that DM2 is the main comorbidity of HF&#46; The time to advance the treatment of DM2 and HF is more than pertinent&#59; the publication of the results from various trials on the use of SGLT2i and GLP-1 for HF open a new horizon for treatment&#44; changes that have already been included in clinical practice guidelines&#46; The data come from one of the few HF registries currently underway in Spain&#58; the national HF registry RICA&#44; which could also provide the results of changes in treatment for the patients&#46; Many of these changes or adjustments could be performed according to the various proposed profiles&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Miramontes Gonz&#225;lez JP&#44; P&#233;rez de Isla L&#46; Insuficiencia card&#237;aca y diabetes&#44; oportunidades de mejora en el tratamiento a trav&#233;s de la caracterizaci&#243;n de pacientes&#46; Rev Clin Esp&#46; 2020&#59;220&#58;437&#8211;438&#46;</p>"
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Editorial
Heart failure and diabetes, opportunities for improving treatment through patient characterization
Insuficiencia cardíaca y diabetes, oportunidades de mejora en el tratamiento a través de la caracterización de pacientes
J.P. Miramontes Gonzáleza,b,
Corresponding author
jpmiramontes@hotmail.com

Corresponding author.
, L. Pérez de Islac,d
a Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain
b Instituto de Ciencias Biomédicas de Salamanca (IBSAL), Universidad Pontificia de Salamanca, Salamanca, Spain
c Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IDISSC), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
d Fundación Hipercolesterolemia Familiar, Madrid, Spain
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