Is Type 2 Diabetes Mellitus an Independent Risk Factor for Mortality in Hypertrophic Cardiomyopathy?

Area of Science:

• Cardiology
• Endocrinology
• Public Health

Background:

• Mortality rates for hypertrophic cardiomyopathy (HCM) have declined, but risk factors for sudden cardiac death (SCD) require ongoing evaluation.
• Current guidelines for HCM risk stratification do not explicitly include Type 2 Diabetes Mellitus (T2DM) due to limited evidence.
• T2DM is a known risk factor for various cardiovascular diseases, prompting investigation into its role in HCM outcomes.

Purpose of the Study:

• To determine if T2DM is associated with an increased 5-year risk of adverse outcomes, including heart failure and all-cause mortality, in patients with HCM.
• To evaluate the impact of T2DM on the prognosis of individuals diagnosed with hypertrophic cardiomyopathy.

Main Methods:

• Retrospective cohort study utilizing the TriNetX database from January 1, 2018, to March 1, 2023.
• Inclusion of 80,502 individuals with HCM, divided into cohorts with (n=15,296) and without (n=58,573) T2DM.
• Survival and risk analyses were performed to assess 5-year all-cause mortality and new-onset heart failure incidence.

Main Results:

• HCM patients with T2DM exhibited a statistically significant increase in all-cause mortality compared to those without T2DM.
• A significant rise in new-onset heart failure was observed in HCM patients with T2DM.
• These findings remained significant after adjusting for major cardiovascular risk factors.

Conclusions:

• This study, one of the largest of its kind, demonstrates a significant association between T2DM and adverse outcomes in HCM patients.
• The results suggest T2DM should be considered a critical risk factor in the management and risk stratification of HCM.
• Further prospective research is warranted to elucidate the specific mechanisms and confirm these findings.