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Does cardiovascular phenotype explain the association between diabetes and incident heart failure? The Strong Heart
G de Simone1, R B Devereux, M J Roman
1Weill Cornell Medical College, New York, NY, USA. simogi@unina.it
Insights
Diabetes significantly increases heart failure (HF) risk, even without heart attacks. Poor blood sugar control in diabetes is a key factor driving this increased HF incidence.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Diabetes is a known risk factor for incident heart failure (HF).
- Initial cardiovascular (CV) characteristics may explain the link between diabetes and HF.
- Understanding these factors is crucial for preventing HF in diabetic populations.
Purpose of the Study:
- To investigate the relationship between diabetes and incident HF, independent of myocardial infarction (MI) and other risk factors.
- To identify specific CV characteristics that predict HF in diabetic individuals.
- To explore the role of metabolic control in diabetes-related HF risk.
Main Methods:
- Analysis of 2757 participants from the 2nd Strong Heart Study, excluding those with prevalent HF, coronary heart disease, or severe kidney dysfunction.
- Cox regression analysis to assess incident HF risk over an average follow-up of 8.9 years, with incident MI treated as a competing risk.
- Statistical models controlled for multiple CV risk factors, including age, BMI, blood pressure, lipids, and inflammatory markers.
Main Results:
- 1278 diabetic participants had a significantly higher incidence of HF (12%) compared to non-diabetic participants (5%), with an odds ratio of 2.89.
- Incident HF was predicted by greater left ventricular (LV) mass index, larger left atrium, lower systolic function, and higher urinary albumin/creatinine ratio.
- Diabetes increased the hazard of HF by 66%, with HbA1c levels explaining a significant portion of this effect.
Conclusions:
- Incident HF is more common in diabetes, independent of MI, abnormal LV geometry, and subclinical dysfunction.
- Poor glycemic control (HbA1c) is a significant driver of HF risk in diabetic patients.
- Identifying high-risk CV phenotypes in diabetes is essential for targeted HF prevention strategies.
Background And Aims:
Diabetes remains a predictor of incident heart failure (HF), independent of intercurrent myocardial infarction (MI) and concomitant risk factors. Initial cardiovascular (CV) characteristics, associated with incident heart failure (HF) might explain the association of diabetes with incident HF.
Methods And Results:
Participants to the 2nd Strong Heart Study exam, without prevalent HF or coronary heart disease, or glomerular filtration rate <30 mL/min/1.73 m(2), were analyzed (n = 2757, 1777 women, 1278 diabetic). Cox regression of incident HF (follow-up 8.91 ± 2.76 years) included incident MI censored as a competing risk event. Acute MI occurred in 96 diabetic (7%) and 84 non-diabetic participants (6%, p = ns). HF occurred in 156 diabetic (12%) and in 68 non-diabetic participants (5%; OR = 2.89, p < 0.001). After accounting for competing MI and controlling for age, gender, BMI, systolic blood pressure, smoking habit, plasma cholesterol, antihypertensive treatment, heart rate, fibrinogen and C-reactive protein, incident HF was predicted by greater LV mass index, larger left atrium, lower systolic function, greater left atrial systolic force and urinary albumin/creatinine excretion. Risk of HF was reduced with more rapid LV relaxation and anti-hypertensive therapy. Diabetes increases hazard of HF by 66% (0.02 < p < 0.001). The effect of diabetes could be explained by the level of HbA1c.
Conclusions:
Incident HF occurs more frequently in diabetes, independent of intercurrent MI, abnormal LV geometry, subclinical systolic dysfunction and indicators of less rapid LV relaxation, and is influenced by poor metabolic control. Identification of CV phenotype at high-risk for HF in diabetes should be advised.
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