Related Experiment Video
Updated: Jan 14, 2026
Modeling and Evaluation of Murine Diabetic Cardiomyopathy Model
Published on: November 29, 2024
Prediction of heart failure as the first major cardiovascular disease event in type 2 diabetes
Julian W Sacre1, Kristin Lundegard2, Kamel Mohammedi3,4
1Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Insights
In type 2 diabetes, heart failure (HF) can precede atherosclerotic cardiovascular disease (ASCVD). Risk factors for HF as the first cardiovascular event differ from those for ASCVD, highlighting distinct pathways in diabetes.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Type 2 diabetes (T2D) increases cardiovascular disease (CVD) risk.
- Heart failure (HF) can be the initial manifestation of CVD in T2D patients, even without prior atherosclerotic cardiovascular disease (ASCVD).
- Understanding distinct risk factors for HF versus ASCVD as first CVD events in T2D is crucial for targeted prevention.
Purpose of the Study:
- To identify risk factors differentiating initial CVD presentation as HF versus ASCVD in individuals with T2D.
- To analyze the specific associations of various risk factors with HF-first events compared to ASCVD-first events.
Main Methods:
- Analysis of participants from the ORIGIN and REWIND trials with T2D and no prior CVD (N=6175).
- Follow-up for incident CVD, categorized as HF event, ASCVD event, or other cardiovascular death.
- Utilized multi-state models to assess event-specific risk factor associations.
Main Results:
- Heart failure was the first CVD event in 16.8% of cases.
- Older age, higher BMI, and elevated urine albumin-to-creatinine ratio were linked to HF-first CVD.
- Worse LDL-cholesterol and HbA1c were more strongly associated with ASCVD-first events.
- Risk factor profiles predicted variable probabilities for HF as the first CVD event (ranging from 5.1% to 32.0%).
Conclusions:
- CVD presenting initially as HF is a significant concern in T2D.
- Distinct risk factors are associated with HF-first versus ASCVD-first cardiovascular events in this population.
- These findings underscore the need for tailored risk assessment and management strategies in T2D.
Aims:
Heart failure (HF) may develop in type 2 diabetes without prior cardiovascular disease (CVD). This study aimed to identify risk factors that distinguish CVD that presents first as a HF event versus CVD that presents first as an atherosclerotic event (ASCVD), among people with type 2 diabetes.
Materials And Methods:
ORIGIN and REWIND trial participants with type 2 diabetes but free of CVD (N = 6175; 64 ± 7 years, 50.1% female) were followed for ~5.8 years for incident CVD presenting first as either a HF event (HF hospitalization or HF death), ASCVD (myocardial infarction, unstable angina, stroke, or revascularization), or other cardiovascular death. Multi-state models characterised event-specific associations of risk factors with each possible first CVD event.
Results:
HF was the first event in 16.8% of 1024 incident CVD cases. Older age, higher BMI, and higher urine albumin:creatinine ratio were more strongly associated with CVD manifesting first as HF, rather than as ASCVD or other cardiovascular death. ASCVD as the first event (65.2% of cases) was more strongly associated with worse LDL-cholesterol and HbA1c. These unique associations of risk factors with HF versus ASCVD translated to variable probabilities of HF as the first CVD event, depending on the clinical profile (32.0% for a profile enriched with HF-specific risk factors versus 5.1% for a profile enriched with ASCVD-specific risk factors).
Conclusions:
CVD that presents first as a HF event is common in type 2 diabetes and its risk factors are distinct from those associated with CVD that presents first as an ASCVD event.
More Related Videos
Related Concept Videos
01:27Heart Failure I: Introduction
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:29Heart Failure II: Pathophysiology
01:17Pathophysiology of Heart Failure
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:30Coronary Artery Disease I: Introduction