Longer duration diabetes, prediabetes increase heart failure risk
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Diabetes duration, including prediabetes, is independently associated with risk for incident heart failure, with greater risks for women and Black adults, according to data presented at the Heart in Diabetes CME Conference.
“Most clinicians are familiar with the concept of ‘pack-years of smoking,’ which captures both burden of smoking — packs per day — and duration — number of years. Similarly, the concept of ‘cholesterol-years’ has been introduced; even those with moderate elevation of LDL-cholesterol, if sustained over many years, will also experience, on average, an earlier onset of atherosclerotic cardiovascular disease risk compared to someone with a similar magnitude of LDL-C elevation but for shorter duration of time,” Erin D. Michos, MD, MHS, FACC, FAHA, FASE, told Healio. “We found that individuals who have been diagnosed with diabetes for longer periods of time were at greater risk for HF, and this is even after accounting for age and other risk factors, such as BMI, blood pressure, lipids, kidney function and concomitant coronary heart disease.”
Justin B. Echouffo Tcheugui, MD, PhD, MPhil, Michos and colleagues analyzed data from 9,734 adults without HF or coronary heart disease (mean age, 63 years; 58% women; 22% Black) who participated in the Atherosclerosis Risk in Communities study from 1987 to 1998. Using diabetes status at four visits spaced 3 years apart and self-reported date of diagnosis for those with diabetes at baseline, the researchers found a nearly threefold increased risk for HF among those with diabetes for at least 15 years (HR = 2.82; 95% CI, 2.22-3.57). In addition, each 5-year increase in diabetes duration was associated with a 17% (95% CI, 11-22) relative increase in HF risk. Results were similar for incident heart failure with preserved or reduced ejection fraction, Michos said during her presentation.
Among participants with diabetes for at least 15 years, risk for HF increased more sharply for Black adults (HR = 4.19; 95% CI, 2.93-5.99) than white adults (HR = 2.04; 95% CI, 1.47-2.83) and for women (HR = 4.49; 95% CI, 3.40-5.93) compared with men (HR = 1.39; 95% CI 0.90-2.15).
Participants with diabetes for at least 15 years who had an HbA1c less than 7% at the ARIC last visit had a twofold increased risk for HF (HR = 2.03; 95% CI, 1.27-3.25), and those with HbA1c at least 7% had a threefold increased risk (HR = 3.2; 95% CI, 2.45-4.17). Prediabetes, defined as HbA1c between 5.7% to 6.4%, increased risk for HF by 16% (HR = 1.16; 95% CI, 1.04-1.29).
“Patients and perhaps their clinicians might not think prediabetes is that big of a deal, except maybe for its associated increased risk of developing diabetes,” Michos told Healio. “But in and of itself, prediabetes is an independent risk factor for heart failure. This is very relevant because 88 million adults — more than 1 in 3 — have prediabetes, and more than 8 in 10 adults don’t know they have prediabetes.”
Strategies for lowering HF risk should include preventing or delaying onset of diabetes and targeting patients with longer diabetes duration with more intensive HF prevention efforts, Michos said.
Reference:
- Echouffo-Tcheugui JB, et al. JACC Heart Fail. 2021;doi:10.1016/j.jchf.2021.06.005.
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Michos ED. Duration of Diabetes and Incident Heart Failure. Presented at: Heart in Diabetes Annual Meeting; Sept. 10-12, 2021 (hybrid meeting).
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