HF after diabetes diagnosis raises 5-year mortality risk, lowers life span
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Patients who developed HF at any time after their diabetes diagnosis had the greatest relative and absolute risk for death at 5 years compared with those with diabetes who had other CV or renal diagnoses, researchers reported.
The study, which was published in Circulation: Cardiovascular Quality and Outcomes also showed that these patients had a decreased life span within 5 years.
“With the emergence of novel treatments such as SGLT2 inhibitors and GLP-1 receptor antagonist medications for type 2 diabetes, some of which are proven to reduce cardiovascular disease risk, clinicians are able to focus on cardiovascular disease and heart failure prevention in patients with type 2 diabetes,” Bochra Zareini, MD, PhD, research fellow at Herlev Gentofte University Hospital in Copenhagen, Denmark, said in a press release. “Our study highlights which subgroups of patients need and could benefit most from targeted risk evaluation, prevention and treatment.”
Data from Danish registries
Researchers analyzed data from 153,405 patients (median age, 64 years; 54% men) with diabetes who did not have ischemic heart disease, HF, chronic kidney disease, stroke, gestational diabetes and peripheral artery disease at baseline.
The outcome of interest was all-cause death, which was assessed during a median follow-up of 9.7 years. During follow-up, 48,087 patients died.
Patients who developed HF within 5 years of a diabetes diagnosis had an elevated 5-year RR for death compared with those who did not have CVD or renal disease (RR = 3; 95% CI, 2.9-3.1). Compared with those who did not have CVD or renal disease, patients who developed other conditions had elevated 5-year risk for death, but not to the same extent as those who developed HF (stroke, RR = 2.2; 95% CI, 2.1-2.2; ischemic heart disease, RR = 1.3; 95% CI, 1.3-1.4; PAD, RR = 2.3; 95% CI, 2.3-2.4; chronic kidney disease, RR = 1.7; 95% CI, 1.7-1.8).
Compared with patients without CV or renal diagnoses, life spans decreased in patients who developed ischemic heart disease (1.6 months; 95% CI, 1.5-1.7), HF (11.7 months; 95% CI, 11.6-11.8), chronic kidney disease (4.4 months; 95% CI, 4.3-4.6), stroke (6.4 months; 95% CI, 6.3-6.5) and PAD (6.9 months; 95% CI, 6.8-7).
The greatest risk for death was observed in patients who developed HF within 5 years after a diabetes diagnosis in combination with chronic kidney disease (63.7%; 95% CI, 53.7-73.7) or stroke (54.1%; 95% CI, 44.7-63.5) compared with other combinations. Patients with HF had the greatest number of months lost when combined with chronic kidney disease (18.2 months; 95% CI, 18.1-18.3), stroke (16.2 months; 95% CI, 16.1-16.4), ischemic heart disease (11 months; 95% CI, 10.9-11.2) or PAD (14.3 months; 95% CI, 14.2-14.4).
Researchers observed similar results in a supplemental analysis when stratified by sex, age, inclusion period and comorbidity status.
Future research
“Treatment effects of different antidiabetic drugs are not covered in the present study as focus was on comparison of different diagnoses,” Zareini and colleagues wrote. “Future studies could potentially separate different antidiabetic drugs effect on certain patient’s risk profile for a more personalized approach in diabetes mellitus management.”
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