Time to address the cardiac metabolic "triple whammy" ischemic heart failure in diabetic patients.

he prevalence of congestive heart failure (CHF), chronic schemic heart disease, and diabetes mellitus is increasing in ost societies, and it is not surprising that in most large linical trials of CHF at least 75% of patients have underying ischemic heart disease while approximately 20% to 5% of patients have diabetes (1,2). There is strong evidence hat the presence of diabetes in patients with CHF is an ndependent marker of adverse prognosis (3), and it has lso been suggested that outcomes tend to be worse in atients with ischemic, as distinct from non-ischemic, ardiomyopathy (4).