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Coexisting HF, type 2 diabetes impacts cardiac remodeling, outcomes, quality of life
In a recent study, patients with HF and coexisting type 2 diabetes had smaller left ventricular volume, higher mitral E/e’ ratio, poorer quality of life and worse clinical outcomes as well as several other phenotype specific differences.
The study, which was published in the Journal of the American Heart Association, evaluated patients in the ASIAN-HF Registry who had HF with reduced ejection fraction (HFrEF; n = 5,028; 21.8% women; mean age, 60 years; 40.2% type 2 diabetes) or HF with preserved ejection fraction (HFpEF; n = 1,139; 49.7% women; mean age, 68.7 years; 45% type 2 diabetes) and a group of community-based participants without HF. According to the results, patients with coexisting type 2 diabetes had a higher incidence of HF rehospitalization (HR = 1.27; 95% CI, 1.05–1.54; P = .014) and higher combined endpoint of all-cause mortality and HF hospitalization at 1 year (HR = 1.22; 95% CI, 1.05–1.41; P = .011), with no differences between HF phenotypes (P for interaction > .05).
“The finding that diabetes mellitus is not independently predictive of death in the present study and other short-term studies, but is with longer-term follow-up, suggests that short-term mortality in patients with HF and diabetes may be determined more by other comorbidities and less by diabetes itself,” the authors wrote. “[However], over longer-term follow-up, the deleterious effects of diabetes on mortality may become more apparent.”
In other findings, patients with HF and diabetes had smaller indexed left ventricular diastolic volumes and higher mitral E/e’ ratio compared with patients without diabetes, and a higher incidence of eccentric hypertrophy in patients with HFrEF and concentric hypertrophy in patients with HFpEF.
Additionally, patients with diabetes and HFrEF or HFpEF had lower scores on the Kansas City Cardiomyopathy Questionnaire for quality of life, with a more prevalent difference in the HFpEF group (P for interaction < .05).
“For a long time, we have known that diabetes impacts negatively on most aspects of health, and our study further supports this notion in the heart failure group,” Jonathan Yap, MBBS, MPH, of the National Heart Center in Singapore, told Cardiology Today. “What is of particular interest is the way in which diabetes affects the structure of the heart in these patients.”
The prevalence of diabetes and HF continues to grow worldwide, and both have become “major worldwide public health issues,” Yap said.
The researchers noted that the prevalence of type 2 diabetes was high in this cohort and varied by region.
“When diabetes and HF occur together, it results in a ‘double whammy,’ with much worse outcomes,” Yap said. “There needs to be synergistic shared care efforts between primary care physicians and cardiologists to improve outcomes. At a governmental level, public health policies to help reduce the incidence of diabetes are also crucial.”
Research in this area will continue, according to the researchers.
“We are planning a multicenter study in Asia on the impact of different treatment strategies in diabetic patients on clinical outcomes,” Yap said. “This will help shed important light on the most effective strategy to help manage and treat patients with diabetes to reduce adverse clinical outcomes like heart failure.” – by Scott Buzby
Disclosures: Yap reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.