Young adults with childhood-onset type 1 diabetes have higher risk for heart failure
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Young adults with childhood-onset type 1 diabetes have a higher risk for heart failure than those without diabetes, and the risk for heart failure increases for those with microvascular disease, according to study data.
“Young adults with type 1 diabetes had a very high risk of heart failure, about 30 times increased risk compared to general population with similar age,” Serena Jingchuan Guo, MD, PhD, assistant professor in the department of pharmaceutical outcomes and policy at the University of Florida College of Pharmacy, told Healio. “In patients with type 1 diabetes, in addition to risk factor assessment for atherosclerotic cardiovascular disease, evaluation of cardiac function should be considered, especially for those with multiple microvascular complications.”
Guo and colleagues analyzed data from a cohort of people with childhood-onset type 1 diabetes who participated in the Pittsburgh Epidemiology of Diabetes Complications study of type 1 diabetes. Those who were diagnosed with diabetes before age 17 years between 1950 and 1980 at the Children’s Hospital of Pittsburgh, were examined between 1986 and 1988, and were free of heart failure at baseline were included. Heart failure was assessed biennially in participants from baseline for 25 years. “Any” heart failure included heart failure as a cause of death, primary hospitalization, clinical signs of heart failure during a clinic examination or self-report of a physician diagnosis. Heart failure as a cause of death or hospitalization was defined as “hard” heart failure. The risk for heart failure in the diabetes cohort was compared with a cohort of healthy young adults aged 18 to 30 years in the CARDIA study followed for 20 years. In CARDIA, heart failure was defined only as a cause of death or hospitalization.
The findings were published in The Journal of Diabetes and Its Complications.
There were 655 young adults with childhood-onset type 1 diabetes included in the study (mean age, 27 years; 50% female). Of the cohort, 6.6% had a heart failure event during follow-up. Of the heart failure events, 53.5% were identified as hard heart failure. The incidence rate for any heart failure was 3.4 per 1,000 person-years and the rate for hard heart failure was 1.8 per 1,000 person-years. The cumulative incidence of heart failure in the diabetes cohort was 1.2% compared with 0.04% in the cohort of adults without diabetes.
In an adjusted model, longer diabetes duration (HR = 2.1; 95% CI, 1.4-3; P < .001), smoking (HR = 2.1; 95% CI, 1.1-4; P = .039), and high triglycerides (HR = 1.5; 95% CI, 1.1-2; P < .001) were associated with an increased risk for any heart failure in young adults with type 1 diabetes. Longer diabetes duration (HR = 2.1; 95% CI, 1.5-3.5; P = .002), lower estimated glomerular filtration rate (HR = 0.6; 95% CI, 0.4-0.9; P = .038), and higher white blood cell count (HR = 1.6; 95% CI, 1.2-2.3; P = .002) were associated with an increased risk for hard heart failure.
Young adults with childhood-onset type 1 diabetes had a higher risk for any heart failure event with the presence of one microvascular disease (HR = 3.1; 95% CI, 1.3-7.6; P = .011) or three microvascular diseases (HR = 4; 95% CI, 1.3-11.9; P = .015) compared with those with no microvascular disease. Guo said it was surprising to see the increased risk with microvascular complications, independent of coronary artery disease.
“Future research is needed to develop screening strategies for cardiac dysfunction in type 1 diabetes, identify modifiable risk factors associated with the increased risk of heart failure and develop intervention strategies to reduce such risk,” Guo said.
For more information:
Serena Jingchuan Guo, MD, PhD, can be reached at guoj1@cop.ufl.edu.
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