Glycemic Markers and Heart Failure Subtypes: The Multi-Ethnic Study of Atherosclerosis (MESA)
Justin B Echouffo-Tcheugui1, Oluseye Ogunmoroti2, Sherita H Golden1
1From the Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Insights
Diabetes significantly increases the risk of heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). Both hemoglobin A1C and fasting plasma glucose in the diabetes range were associated with higher HF risks.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Diabetes mellitus is a known risk factor for heart failure (HF).
- The specific associations between dysglycemia markers and HF subtypes (HFpEF and HFrEF) remain incompletely understood.
- Understanding these relationships is crucial for risk stratification and prevention strategies.
Purpose of the Study:
- To investigate the association of various dysglycemia markers with the risk of developing HFpEF and HFrEF.
- To compare the risks conferred by different glycemic statuses and specific markers.
Main Methods:
- A cohort of 6688 adults without prevalent cardiovascular disease was followed for incident hospitalized HF.
- Adjusted Cox models were used to evaluate the association of glycemic markers (HbA1C, FPG, HOMA-IR, fasting insulin) and status (normoglycemia, prediabetes, diabetes) with HFpEF and HFrEF.
- Median follow-up was 14.9 years, during which 356 HF events occurred.
Main Results:
- Diabetes status significantly increased the risk of both HFpEF (HR 1.85) and HFrEF (HR 2.02) compared to normoglycemia.
- Elevated hemoglobin A1C (≥6.5%) and fasting plasma glucose (≥126 mg/dL) were similarly associated with increased risks of HFpEF and HFrEF.
- Prediabetic ranges of HbA1C or FPG, HOMA-IR, and fasting insulin were not significantly linked to HF risk.
Conclusions:
- In community-dwelling individuals, diabetes-range HbA1C and FPG are independently associated with elevated risks of both HFpEF and HFrEF.
- The magnitude of risk for both HF subtypes was similar for these two key glycemic markers.
- These findings highlight the importance of glycemic control in preventing heart failure.
Background:
Although diabetes increases heart failure (HF) risk, it is unclear how various dysglycemia markers (hemoglobin A1C [HbA1C], fasting plasma glucose [FPG], homeostasis model assessment of insulin resistance, and fasting insulin) are associated with HF subtypes (HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction [HFrEF]). We assessed the relation of markers of dysglycemia and risks of HFpEF and HFrEF.
Methods And Results:
We included 6688 adults without prevalent cardiovascular disease who attended the first MESA visit (2000-2002) and were followed for incident hospitalized HF (HFpEF or HFrEF). Association of glycemic markers and status (normoglycemia, prediabetes, diabetes) with HFpEF and HFrEF were evaluated using adjusted Cox models. Over a median follow-up of 14.9 years, there were 356 HF events (145 HFpEF, 173 HFrEF, and 38 indeterminate HF events). Diabetes status conferred higher risks of HFpEF (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.57-2.68) and HFrEF (HR 2.02, 95% CI 1.38-2.97) compared with normoglycemia. Higher levels of FPG (≥126 mg/dL) and HbA1C (≥6.5%) were associated with similarly higher risks of HFpEF (HR for FPG 1.96, 95% CI 1.21-3.17; HR for HbA1C 2.00, 95% CI 1.20-3.31) and HFrEF (HR for FPG 1.84, 95% CI 1.18-2.88; HR for HbA1C 1.99, 95% CI 1.28-3.09) compared with reference values. Prediabetic range HbA1C (5.7%-6.4%) or FPG (100%-125 mg/dL), homeostasis model assessment of insulin resistance, and fasting insulin were not significantly associated with HFpEF or HFrEF.
Conclusions:
Among community-dwelling individuals, HbA1C and FPG in the diabetes range were each associated with higher risks of HFpEF and HFrEF, with similar magnitudes of their associations.
Lay Abstract:
Heart failure (HF) has 2 major subtypes (the heart's inability to pump or to fill up). Diabetes is known to increase HF risk, but its effects and that of markers of high glucose levels (fasting blood glucose and hemoglobin A1C) on the occurrence of HF subtypes remains unknown. Among 6688 adults without known cardiovascular disease followed for nearly 15 years, diabetes conferred significantly higher risks of both HF types, compared with those with normal blood glucose levels. Higher levels of fasting blood glucose and hemoglobin A1C were similarly associated with higher risks of both types of HF.
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