ACE inhibitors or ARBs can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors. IIa A for ACE inhibitor, B for ARBs for prevention of HF ACE indicates angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; COR, Class of Recommendation; HF, heart failure; and LOE, Level of Evidence. Bozkurt et al dysfunction, and obesity. In addition, diabetes mellitus may independently contribute to cardiac dysfunction in the absence of these risk factors (ie, diabetic car- diomyopathy). Potential pathogenic factors contribut- ing to cardiac dysfunction in patients with diabetes mellitus include the direct and indirect effects of hy- perglycemia and advanced glycation end products, autonomic dysfunction, microangiopathy, subclinical macrovessel (coronary) disease, mitochondrial dysfunction, lipotoxicity, and potential Association of Diabetes Mellitus With Outcomes in Patients With Established HF Diabetes mellitus is commonly present in patients with HF. 