Heart failure with preserved ejection fraction, diabetes exacerbate one another

PHILADELPHIA — There is a strong link between heart failure with preserved ejection fraction and diabetes, and the conditions often make each other worse, a speaker said at the Heart in Diabetes Medical Conference.

Ejection fraction is an important measurement in the diagnosis and surveillance of heart failure (HF), however, it is possible for patients with normal ejection fraction to have HF, and this form of the disease, HF with preserved ejection fraction, or HFpEF, is becoming increasingly prevalent, Eldrin F. Lewis, MD, MPH, FAHA, cardiologist from Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, said during a presentation.

It is known that that patients with HFpEF commonly have diabetes, regardless of age. Lewis said clinical trial data show that patients with HFpEF tend to be younger, female and have a higher BMI, but in real-world data, patients with HFpEF tend to be older and have lower BMI.

According to Lewis, when looking at total risk for patients, HF is almost as common as CV death and is the most common nonfatal event. Patients with diabetes who have been hospitalized with HF have a much higher risk for mortality than patients with diabetes who have never been hospitalized for it, he said.

“As we move forward, I think that the future of HFpEF is not just focusing on the mechanistic issues but understanding that these are complex patients and I think that with HF in diabetes, because of their increased risk, we have to first come up with a more standardized approach to the diagnosis,” he said. “Diabetes and HFpEF frequently coexist, and each increases the risk of the other.”

According to Lewis, novel therapies have to focus on both HFpEF and diabetes and in the future, physicians should look at more than just a single biomarker and focus on understanding the entirety of the patient management.

“We need to assess the safety and efficacy of novel drugs for diabetes and include HF as part of the primary outcome measure and realize that several factors that are modifiable influence outcomes,” Lewis said. “We need to work together, including with primary care doctors, to modify these risk factors before they develop either and finally future studies should target improvements across the disease spectrum.”– by Dave Quaile

Reference:

Lewis EF. Congestive Heart Failure in Diabetes. Presented at: Heart in Diabetes Medical Conference; July 14-16, 2017; Philadelphia.

Disclosure: Lewis reports receiving research support from Novartis and Sanofi.