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Impact of diabetes on outcomes in hypertrophic cardiomyopathy: a GRADE meta-analysis

Seyedeh-Tarlan Mirzohreh1,2, Niloofar Deravi3, Elnaz Javanshir1

  • 1Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Heart (British Cardiac Society)
|October 8, 2025
PubMed

Insights

Diabetes mellitus (DM) significantly increases risks for patients with hypertrophic cardiomyopathy (HCM), leading to higher mortality, heart failure, and atrial fibrillation. Closer monitoring and potential interventions are crucial for managing this comorbidity.

Area of Science:

  • Cardiology
  • Endocrinology
  • Genetics

Background:

  • Diabetes mellitus (DM) is a common comorbidity in hypertrophic cardiomyopathy (HCM).
  • The prognostic impact of DM on HCM outcomes and cardiac structure remains uncertain.
  • DM may exacerbate arrhythmic risk and worsen heart failure in HCM patients.

Purpose of the Study:

  • To systematically evaluate the prognostic impact of DM in adults with HCM.
  • To assess the effect of DM on clinical outcomes and cardiac structure/function in HCM.
  • To synthesize evidence from observational studies using meta-analysis.

Main Methods:

  • Systematic literature search of PubMed, Scopus, Web of Science, and Cochrane up to January 2025.
  • Random-effects meta-analyses of observational studies comparing adults with HCM-DM vs. HCM without DM.
  • Assessment of evidence certainty using GRADE framework after ROBINS-I evaluation.

Main Results:

  • Eight studies (47,592 patients) found DM associated with higher odds of all-cause mortality (OR 1.43), heart failure (OR 1.34), and atrial fibrillation (OR 1.41).
  • DM linked to smaller left ventricular end-diastolic volumes and impaired global longitudinal strain, suggesting subclinical dysfunction.
  • Evidence for effects on ejection fraction, mass, and septal thickness was inconclusive; results were robust across sensitivity analyses.

Conclusions:

  • Diabetes mellitus is a significant risk marker in hypertrophic cardiomyopathy.
  • DM is associated with increased mortality, heart failure, atrial fibrillation, and adverse cardiac changes in HCM.
  • Closer monitoring of rhythm and function in HCM-DM patients is recommended; further research on metabolic interventions is needed.
Abstract

Keywords:
Cardiomyopathy, HypertrophicDiabetes MellitusMeta-AnalysisSystematic Reviews as Topic

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