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Diabetes increases mortality rate in overt heart failure
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Among adults with asymptomatic left ventricular systolic dysfunction who developed heart failure, those with diabetes had increased risks for heart failure hospitalization, cardiovascular death and death from any cause compared with those without diabetes, study data show.
John J. V. McMurray, MD, FRCP, FESC, FACC, FAHA, FRSE, FMedSci, professor of cardiology at the BHF Cardiovascular Research Centre at the University of Glasgow in the United Kingdom, and colleagues evaluated data from the Studies of Left Ventricular Dysfunction on 4,223 adults with asymptomatic left ventricular systolic dysfunction with diabetes (n = 647; mean age, 61 years; 85% men; 76% white) or without diabetes (n = 3,576; mean age, 58 years; 89% men; 88% white) to determine the role of diabetes in the transition from asymptomatic left ventricular systolic dysfunction to overt heart failure (HF).
During a median follow-up of 36 months, 24.1% of participants without diabetes developed HF compared with 33.1% with diabetes. Compared with participants without diabetes, those with diabetes had higher risks for HF hospitalization (P < .0001), the composite endpoint of development of HF or CV death (P < .0001) and death from any cause (P = .001).
Before development of HF, 5.9% of participants without diabetes experienced an incident myocardial infarction compared with 5.6% of participants with diabetes. The risk for HF was significantly higher among participants with diabetes compared with participants without diabetes in analyses including MI as a time-dependent covariate (adjusted HR = 1.3; 95% CI, 1.11-1.52). The risk for HF hospitalization was also higher among participants with diabetes compared with participants without diabetes (110 per 1,000 person-years vs. 55 per 1,000 person-years; P < .0001).
During 4 years or less of follow-up, the risk for death was lower among participants without diabetes who did not develop HF compared with participants with diabetes who did not develop HF (14% vs. 22%). The risk for death was also lower in participants without diabetes who developed HF compared with participants with diabetes who developed HF (29% vs. 37%).
“In patients with [asymptomatic left ventricular systolic dysfunction], diabetes is associated with an increased risk of developing HF, HF hospitalization and cardiovascular death,” the researchers wrote. “The relative risk of death in patients who develop HF (vs. those who do not) is similarly high, irrespective of diabetes status. This information might help in the development of strategies to prevent the transition from [asymptomatic left ventricular systolic dysfunction] to overt HF.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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