Diabetes an Independent Risk Factor for Heart Failure

Heart problems are a known complication of diabetes, accounting for a large portion of morbidity and mortality in patients.

Cardiovascular complications may include coronary artery disease, stroke, atherosclerosis, hypertension, and heart failure (HF), with approximately 33% of patients hospitalized with HF being those with diabetes. The development of HF with diabetes is particularly prevalent in older patients.¹

A new study published in Mayo Clinic Proceedings examined diabetes as an independent predictor of HF. The researchers used the Rochester Epidemiology Project to evaluate the long-term effect of diabetes on the development of HF, both with preserved ejection fraction and reduced ejection fraction.¹

A scientific statement released last June by the American Heart Association indicated that type 2 diabetes is a risk factor for incident HF, saying that “secular trends in the prevalence of diabetes mellitus and heart failure forecast a growing burden of disease and underscore the need for effective therapeutic strategies.” The paper also called for a “team-based approach” for caring for patients with diabetes and HF, comprising of several different members of the health care team, including pharmacists.²

The most recent analysis included 116 patients with diabetes and 232 without diabetes. Patients who were enrolled underwent a physical examination with baseline blood work. Body mass index, blood pressure, height, and weight were obtained during the initial data collection period. Of the patients identified who did not participate in the study, 500 were randomly selected and their medical records were reviewed. All participants completed medical surveys and questionnaires.¹

Of the patients with diabetes, 21% were defined as insulin-dependent and maintained on treatment with insulin alone, according to the study. No patients in the study were maintained on the newer oral antidiabetic drugs.¹

According to the findings, over the 10-year follow-up period, 21% of participants with diabetes developed HF, independent of other causes. The study did not find a statistically significant difference in cardiac death, heart attack, or stroke between the 2 groups.¹

The researchers noted that, despite the absence of cardiac structure abnormality, patients with diabetes are at increased risk for developing HF. Notably, the study also showed that in the subgroup of the cohort with normal left ventricular filling pressure, diabetes was still associated with increased risk for the development of HF.¹

“The key takeaway is that diabetes mellitus alone is an independent risk factor for the development of heart failure,” senior study author Horng Chen, MD, cardiologist at Mayo Clinic, said in a press release.³ “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.”

References:

• Klajda MD, Scott CG, Rodeheffer RJ, et al. Diabetes mellitus is an independent predictor for the development of heart failure. Mayo Clinic Proceedings. 2020. DOI: https://doi.org/10.1016/j.mayocp.2019.07.008

• Dunlay SM, Aguilar D, Allen LA. Type 2 diabetes mellitus and heart failure. Circulation. 2019. Doi: 10.1161/CIR.0000000000000691

• Diabetes can independently lead to heart failure, population study shows [news release]. Mayo Clinic’s website. https://newsnetwork.mayoclinic.org/discussion/diabetes-can-independently-lead-to-heart-failure-population-study-shows/. Accessed January 2, 2020.