Heart Failure Associated with Worst Prognosis Among CVDs, CKD in Diabetics

Bochra Zareini, MD, PhD

While the impact of cardiovascular comorbidities is of the utmost concern for clinicians treating diabetic patients, new research suggests development of heart failure was associated with the greatest risk of death among type 2 diabetics with cardiovascular conditions.

Results of the study, which compared the impact of heart failure against other cardiovascular conditions and chronic kidney disease (CKD), found a diagnosis of heart failure within 5 years of a type 2 diabetes diagnosis was associated with a 3 times greater risk of death and an 11-month decrease in life expectancy.

“With the emergence of novel treatments such as SGLT2 inhibitors and GLP-1 receptor antagonist medications for Type 2 diabetes, some of which are proven to reduce cardiovascular disease risk, clinicians are able to focus on cardiovascular disease and heart failure prevention in patients with Type 2 diabetes,” said lead investigator Bochra Zareini, MD, PhD, research fellow at Herlev Gentofte University Hospital in Copenhagen, Denmark, in a statement from the American Heart Association. “Our study highlights which subgroups of patients need and could benefit most from targeted risk evaluation, prevention and treatment.”

With type 2 diabetics at an exponentially higher risk for developing heart failure and a renewed emphasis on treatment of heart failure in patients with and without diabetics, Zareini and a team of colleagues designed a retrospective, longitudinal study with the goal of further describing the risk and impact of heart failure in patients with newly diagnosed type 2 diabetes. Using Danish health registry data, the team identified a total of 153,403 patients who met inclusion criteria during a period lasting from 1998-2015.

For inclusion in the study, patients needed to be 18 years of age or older with a first-time redeemed prescription of a non-insulin antidiabetic drug during the study period. Patients with a history of heart failure, ischemic heart disease (IHD), stroke, CKD, peripheral artery disease (PAD), and gestational diabetes mellitus were excluded from the investigators’ analysis.

The overall goal of the study was to assess the 5-year risk of death, 5-year risk ratios (RR), and the decrease in lifespan within 5 years associated with the development of any cardiovascular disease or CKD.

For the 153,504-patient cohort, the median duration of follow-up was 9.7 years. During the study period, 45.1% (n=69,201) patients developed cardiovascular or renal disease and a total of 48,087 patients died. Of the patients who received a diagnosis, 45,155 (62.3%) received 1 diagnosis, 17,309 received 2 diagnoses, and 8737 received 3 or more. Investigators highlighted the average number of diagnoses per patient during the study period was 0.7.

Analysis revealed patients who developed heart failure within 5 years of a type 2 diabetes diagnosis had a 3 (95% CI, 2.9-3.1) times greater risk of mortality than those free of diagnoses. In comparison, stroke was associated with a 1.3 (1.3-1.4) times greater risk, stroke correlated to a 2.2 (2.1-2.2) times greater risk, CKD correlated to a 1.7 (1.7-1.8) times greater risk, and PAD correlated with a 2.3 (2.3-2.4) times greater risk of mortality compared to patients without cardiovascular or renal diagnoses.

Additionally, analyses indicated heart failure was associated with an 11.7 (11.6-11.8) month decrease in life expectancy within 5 years compared to patients without a diagnosis. In comparison, IHD was associated with a 1.6 (1.5-1.7) month reduction, stroke was associated with a 6.4 (6.4-6.5) month reduction, CKD was associated with a 4.4 (4.3-4.6) month reduction, and PAD was associated with a 6.9 (6.8-7.0) month reduction in life expectancy within 5 years.

Investigators pointed out a supplemental analysis produced similar results when stratified according to age, sex, comorbidity status, and inclusion period. Investigators also urged caution when interpreting results of their study due to recent advances in therapies and a lack of information related to clinical factors detailing the severity of cardiovascular disease and diabetes.

This study, “Type 2 Diabetes Mellitus and Impact of Heart Failure on Prognosis Compared to Other Cardiovascular Diseases,” was published in Circulation: Cardiovascular Quality and Outcomes.