Diabetes Independently Associated With Increased Risk of Heart Failure

Horng Chen, MD

While mountains of research have detailed how diabetes and associated risk factors are associated with cardiovascular issues, new data from the Mayo Clinic suggest diabetes may be an independent risk factor for heart failure.

A team of Mayo Clinic physicians performed a population-based study and found patients with diabetes developed heart failure at nearly twice the rate of patients without diabetes, even after adjustment for other risk factors.

"The key takeaway is that diabetes mellitus alone is an independent risk factor for the development of heart failure," said Horng Chen, MD, a cardiologist at the Mayo Clinic in Rochester, MN, in a press release. "Our hope is that this study provides a strong foundation for further investigations into diabetes and heart failure. There is still much to learn and study in terms of this association and how to best diagnose and treat this condition."

In an effort to determine the role of diabetes mellitus in the development of cardiovascular diseases in a community-based population, investigators performed a cross-sectional survey of patients from the Rochester Epidemiology Project (REP). From the REP, investigators created a cohort of 2042 randomly selected residents from Olmsted County, MN to compare rates of heart failure regardless of factors including age, sex, hypertension, and coronary artery disease status.

All participants included in the study took place in a physical examination, baseline blood work, and echocardiography between June 1, 1997, and September 30, 2000. Of the 2042 participants, 116 had a diagnosis of diabetes mellitus. Participants with diabetes mellitus were matched in a 1:2 ratio with a cohort of 232 participants without a diagnosis of diabetes matched for the aforementioned risk factors.

Investigators noted differences in baseline characteristics between the diabetic and non-diabetic populations. These differences included increased BMI (316 kg/m2 versus 295 kg/m2) and higher percentages of atrial fibrillation (9% versus 4%) and baseline heart failure (3% versus 0%) in participants with diabetes mellitus. Additionally, 21% of patients with diabetes mellitus were classified as insulin-dependent diabetics and the differences in the prevalence of comorbid conditions including stroke, hypertension, and coronary artery disease were not statistically significant between the groups (P>0.05).

During a median follow-up period of 10.05 years, 21% of patients with diabetes mellitus developed heart failure independent of other risk factors compared to 12%( HR, 1.2; 95% confidence limits, 0.8-1.7; P=0.85) of patients without diabetes. Investigators noted rates of all-cause mortality were similar between patient groups regardless of diabetes status.

Additional analyses were performed by investigators examining subgroups of patients with and without diastolic dysfunction with matched controls. Patients in the subgroup without diastolic dysfunction, patients with diabetes mellitus had a higher rate of heart failure over the 10-year follow-up than patients without diabetes mellitus (HR, 2.5; 95% confidence limits, 1.0-6.3; P=0.04). Overall, 13% of patients with diabetes mellitus developed heart failure compared to 7% of patients without diabetes.

Investigators suggest data from their study indicate diabetes is an independent risk factor for the development of heart failure and point out it supports the concept of diabetes mellitus cardiomyopathy.

This study, titled “Diabetes Mellitus Is an Independent Predictor for the Development of Heart Failure: A Population Study,” was published online in Mayo Clinic Proceedings.