Quantifying the Risk of Recurrent, New-Onset Heart Failure with Diabetes

This story originally appeared on Endocrinology Network's sister site, PracticalCardiology.com.

Results of a new systematic review and meta-analysis are offering updated insight on associations between diabetes mellitus and risk of new-onset and recurrent heart failure.

An analysis of more than 70 published articles, findings from the study provide an updated overview of the increased risks of new-onset and recurrent heart failure, respectively, associated with diabetes mellitus.

“These findings help to specify the populations that should be the focus of preventive strategies for diabetes mellitus-related heart failure. It is also indicated that diabetes mellitus is associated with future HFpEF and HFrEF to the same extent,” wrote study investigators.”

While mountains of data have established associations between diabetes mellitus and increased risk of heart failure, the exact magnitude of risk remains a topic of discussion among clinicians. To bring further clarity to this conversation, investigators designed the current meta-analysis to separately assess the risk of new-onset and recurrent heart failure depending on a patient’s diabetes status.

With this in mind, investigators designed their study to search the EMBASE and MEDLINE databases for cohort studies published up to July 28, 2019. Investigators established 4 main inclusion criteria for articles. From their search, investigators identified a total of 74 and 38 studies examining new-onset and recurrent heart failure, respectively.

To be included in the analysis, articles needed to be considered a cohort study, have information related to diabetes status of all participants, contain at least 6 months of follow-up data, and have diabetes mellitus as an exposure. Investigators planned to pool respective risk ratios for individuals with diabetes mellitus compared to those without diabetes mellitus through use of a random-effects model.

Among the studies examining new-onset heart failure, the pooled RR for heart failure as a whole was 2.14 (95% CI, 1.96-2.34). Investigators pointed a large between-study heterogeneity was significantly explained by mean age (P <.001). When examining studies detailing incidence of HFpEF, investigators found the pooled RR was 2.22 (95% CI, 2.02-2.43). In studies detailing the incidence of HFrEF, the pooled RR was 2.73 (95% CI, 2.71-2.75).

When assessing the 38 studies included in the recurrent heart failure analysis, investigators found the pooled RR was 1.39 (95% CI, 1.33-1.45). Investigators noted the large between-study heterogeneity seen in this group of studies was significantly explained by the proportion of men (P= 0.01) or the large pooled RR for studies of only participants with HFpEF (P=.002)].

Investigators purported the results of their analyses indicate diabetes mellitus is a significant risk of both new-onset and recurrent heart failure. Additionally, investigators pointed out the risk magnitude appeared to be large for new-onset heart failure in your populations.

“The present results indicate that diabetes mellitus is a significant risk factor for both new-onset and recurrent HF. It is suggested that the risk magnitude is large for new-onset HF especially in young populations and for recurrent HF especially in women or those with HFpEF,” wrote study investigators.

This study, “Diabetes mellitus and risk of new-onset and recurrent heart failure: a systematic review and meta-analysis,” was published in ESC Heart Failure.