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Association between diabetes and heart failure after coronary artery bypass grafting: Danish register-based cohort
Benedicte Bay Oxholm Brodersen1, Line Tribler Kristiansen1, Sidsel le Fevre Karlsen1
1The Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Insights
Patients with diabetes mellitus (DM) face a significantly higher risk of heart failure (HF) after coronary artery bypass grafting (CABG). This increased risk persists for up to ten years post-surgery, highlighting a critical concern for this patient group.
Area of Science:
- Cardiovascular Medicine
- Diabetology
- Surgical Outcomes Research
Background:
- Ischemic heart disease (IHD) is a leading global cause of mortality.
- Diabetes mellitus (DM) affects approximately 25% of patients undergoing coronary artery bypass grafting (CABG).
- DM patients exhibit a heightened risk of mortality from heart failure (HF) post-revascularization.
Purpose of the Study:
- To compare the risk of developing heart failure (HF) after coronary artery bypass grafting (CABG) in patients with and without diabetes mellitus (DM).
Main Methods:
- A large, nationwide, register-based cohort study included patients who underwent CABG between 2000 and 2020.
- Cox regression and g-formula methods were employed to analyze the association between DM status and HF outcomes.
- Absolute risk (AR) and risk difference (RD) were calculated for HF and mortality.
Main Results:
- The study included 34,855 patients, with 19.8% having DM.
- The 10-year absolute risk of HF after CABG was 35.1% for DM patients versus 26.4% for non-DM patients (p < 0.001).
- The risk difference for HF was notably higher in DM patients, increasing from 3.7 percentage points (pp.) at year 1 to 8.6 pp. at year 10.
Conclusions:
- Patients with diabetes mellitus (DM) experience a significantly elevated risk of heart failure (HF) following coronary artery bypass grafting (CABG).
- This increased HF risk in DM patients persists for up to ten years post-CABG.
- The findings underscore the importance of managing DM in patients undergoing CABG to mitigate long-term HF risk.
Background:
Ischemic heart disease (IHD) is the leading cause of mortality in the world with an increasing incidence. One of the interventions to treat IHD is coronary artery bypass grafting (CABG) and people with diabetes mellitus (DM) account for approximately one quarter of all patients who undergo coronary revascularization. Furthermore, people with DM have a higher risk of mortality due to heart failure (HF).
Objective:
We aim to describe the risk of developing HF after CABG in patients with versus without DM.
Methods:
Through a large nationwide register-based cohort study, patients who underwent CABG from January 1, 2000 to December 31, 2020 were included. In addition to Cox regression, g-formula methods based on multivariable Cox regression were performed to estimate the absolute risk (AR) and risk difference (RD) of the association between DM status and HF outcome, and between DM status and mortality.
Results:
A total of 34,855 patients were included in this study, consisting of 6909 (19.8%) DM patients. The AR of HF after CABG in the 10th year was 35.1% versus 26.4% for patients with versus without DM (p < 0.001), respectively. The RD of HF for each exceeding year (3.7 percentage point (pp.) in the 1st year versus 8.6 pp. in the 10th year) was higher for patients with DM compared to those without DM.
Conclusion:
The risk of HF was significantly higher up to ten years after CABG in patients with DM compared to those without DM.
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