Diabetes with cardiomyopathy confers elevated risk for HF
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Adults with diabetes with cardiomyopathy were at significantly higher risk for developing incident HF, according to new data published in the Journal of the American College of Cardiology.
“Individuals with diabetes have abnormalities in several inter-related as well as independent measures of cardiac structure, function and biomarkers,” Matthew W. Segar, MD, MS, cardiology fellow in the division of cardiology in the department of internal medicine at the University of Texas Southwestern Medical Center and the Parkland Health and Hospital System, Dallas, and colleagues wrote. “However, the optimal criteria to identify diabetes with cardiomyopathy and its prognostic implications for the risk of incident HF are not well established.”
Researchers pooled 10,208 adults without prevalent CVD or HF from the Atherosclerosis Risk in Communities, Cardiovascular Health Study and Chronic Renal Insufficiency Cohort studies. Of these, 2,900 (28.4%) adults had diabetes. Diabetes with cardiomyopathy was defined as the following:
- least restrictive: one or more echocardiographic abnormality (n = 1,942);
- intermediate restrictive: two or more echocardiographic abnormalities (n = 579); or
- most restrictive: elevated N-terminal pro-B-type natriuretic peptide levels of less than 125 pg/mL in individuals with normal weight or overweight or less than 100 pg/mL in individuals with obesity plus two or more echocardiographic abnormalities (n = 338).
Diabetes with cardiomyopathy prevalence was 67% in the least restrictive category, 20% in the intermediate restrictive category and 11.7% in the most restrictive category. Researchers observed higher fasting glucose, BMI, age and worse kidney function as factors associated with higher diabetes with cardiomyopathy risk. Among those with diabetes with cardiomyopathy, 433 (4.2%) experienced incident HF. The 5-year HF incidence rate was 8.4% in the least restrictive category, 11.2% in the intermediate restrictive category and 12.8% in the most restrictive category.
Compared with euglycemia, diabetes with cardiomyopathy was significantly associated with a higher incident HF risk regardless of whether the most restrictive (HR = 2.55; 95% CI, 1.69-3.86) or least restrictive (HR = 1.99; 95% CI, 1.5-2.65) category was used. Similar results were observed across all three cohort studies, sex and race subgroups and among those without hypertension or obesity.
“These results highlight the prognostic importance of identifying a universally accepted clinical definition and diagnostic approach to diabetes with cardiomyopathy to identify individuals at high risk of progression to HF,” Vanita R. Aroda, MD, from the division of endocrinology, diabetes and hypertension at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote in an accompanying editorial. “Establishing a unique diagnostic phenotype and standardized clinical approach, utilizing the advances of imaging and biomarkers, could help to slow or prevent the progression of incident HF long before the advent of symptoms.”
According to Aroda and colleagues, though these findings are relevant, they do not demonstrate direct causality between diabetes, diabetes with cardiomyopathy and HF.
“Interdisciplinary dialogue, continued generation of evidence to support best practices and consensus guidance will undoubtedly evolve the current state of knowledge to the ultimate goal of prevention, which is critically needed to reduce the overall disease burden of diabetes and HF,” the editorial authors wrote.
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