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Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study
Justin B Echouffo-Tcheugui1, Sui Zhang2, Roberta Florido3
1Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Longer diabetes duration significantly increases heart failure (HF) risk. Each 5-year increase in diabetes duration elevates HF risk by 17%, highlighting the importance of managing diabetes duration for HF prevention.
Area of Science:
- Cardiology
- Endocrinology
- Epidemiology
Background:
- Diabetes mellitus is a known risk factor for heart failure (HF).
- The independent impact of diabetes duration on the incidence of HF remains unclear.
- Understanding this relationship is crucial for targeted HF prevention strategies.
Purpose of the Study:
- To assess the association between the duration of diabetes and the risk of developing incident heart failure (HF).
- To investigate how different durations of diabetes influence HF incidence in a large cohort.
- To identify subgroups potentially at higher risk based on diabetes duration.
Main Methods:
- Utilized data from 9,734 participants in the Atherosclerosis Risk In Communities (ARIC) study, without prior HF or coronary heart disease.
- Calculated diabetes duration using data from four study visits and self-reported diagnosis dates.
- Employed Cox regression analysis, adjusting for covariates and performing stratified analyses by age, race, sex, and glycemic control (HbA1c).
Main Results:
- Over 22.5 years, 1,968 HF events occurred. HF risk increased with longer diabetes duration, with the highest risk observed for durations of 15 years or more (HR: 2.82).
- A 5-year increase in diabetes duration was associated with a 17% relative increase in HF risk.
- The association between diabetes duration and HF was more pronounced in younger individuals (<65 years), those with HbA1c ≥7%, obesity (BMI ≥30 kg/m²), women, and Black participants.
Conclusions:
- Longer diabetes duration is independently associated with a significantly increased risk of incident heart failure.
- Strategies aimed at delaying diabetes onset could enhance heart failure prevention efforts.
- Therapeutic interventions targeting heart failure outcomes may benefit from focusing on patients with long-standing diabetes.
Objectives:
This study assessed the association of diabetes duration with incident heart failure (HF).
Background:
Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown.
Methods:
We included 9,734 participants (mean age 63 years, 58% women, 22% Black) at ARIC (Atherosclerosis Risk In Communities) Visit 4 (1996-1998) without HF or coronary heart disease. We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first 4 ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident HF, accounting for intercurrent coronary heart disease and other risk factors. We performed analyses stratified by age (<65 years or ≥65 years), race, sex, and glycemic control (hemoglobin A1C [HbA1C] consistently <7%, vs HbA1C ≥7%), with tests for interaction.
Results:
Over 22.5 years of follow-up, there were 1,968 HF events. Compared to those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with ≥15 y diabetes duration (HR: 2.82; 95% CI: 2.25-3.63). Each 5-year increase in diabetes duration was associated with a 17% (95% CI: 11-22) relative increase in HF risk. Similar results were observed across HF subtypes. The HF and diabetes duration associations were stronger among those aged <65 years, those with HbA1C ≥7%, those with a body mass index ≥30 kg/m2, women, and Blacks (all P interactions <0.05).
Conclusions:
Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.
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