medwireNews: The presence of cardiac abnormalities in people with diabetes forewarns of an increased risk for incident heart failure over the next few years, say researchers.
Ambarish Pandey (University of Texas Southwestern Medical Center, Dallas, USA) and co-researchers assessed data from 10,208 participants of the prospective cohort studies ARIC, CHS, and CRIC.
In all, 28.4% of these people had diabetes, among whom “the burden of subclinical abnormalities in cardiac structure and function [was] high even in the absence of other risk factors such as hypertension and obesity,” reports the research team in the Journal of the American College of Cardiology.
The prevalence of diabetic cardiomyopathy, when defined as at least one abnormality on echocardiography (elevated left ventricular mass, left atrial enlargement, or diastolic dysfunction) with no likely cause other than diabetes, was 67.0%. When defined as at least two abnormalities, or as two plus elevated natriuretic peptide levels, the prevalence rates were 20.0% and 11.7%, respectively.
In a linked editorial, Vanita Aroda (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and co-authors stress that this wide variation in prevalence “clearly demonstrates the need for refinement” of diabetic cardiomyopathy criteria.
Among people with diabetes, those with cardiomyopathy were older than those without and had higher glucose levels and BMI. Diastolic dysfunction was the most common indicator of diabetic cardiomyopathy.
The 5-year incidence of heart failure was 8.4% among people with at least one cardiac abnormality, but these events accounted for 78.5% of all heart failure events in people with diabetes.
The heart failure incidence rate among people with diabetic cardiomyopathy by the strictest criteria was higher, at 12.8%, but these events accounted for a considerably smaller 21.0% of all events. The heart failure rate was 11.2% among people with an intermediate cardiomyopathy definition.
Relative to people with normal glucose levels, the risk for heart failure was not significantly increased in those with prediabetes or with diabetes but no evidence of cardiomyopathy after accounting for factors including age, sex, race, blood pressure, BMI, kidney function, and lipid levels.
But the risk was significantly increased for people with diabetic cardiomyopathy, starting at a hazard ratio of 1.99 using the least restrictive definition and rising to 2.55 with the most restrictive definition.
The editorialists stress that although diabetic cardiomyopathy “represents a distinct pathogenic process, it is frequently clinically underrecognized owing to its asymptomatic nature and multiple comorbidities that confound diagnosis.”
They say that diabetic cardiomyopathy “represents a pivotal stage in the pathway of preventable functional decline, a time point before significant morbidity has set in,” which “represents a window of opportunity for prevention and treatment of [heart failure].”
The findings therefore “highlight the prognostic importance of identifying a universally accepted clinical definition and diagnostic approach to [diabetic cardiomyopathy] to identify individuals at high-risk of progression to [heart failure],” Aroda and co-authors conclude.
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J Am Coll Cardiol 2021; 78: 1587–1598
J Am Coll Cardiol 2021; 78: 1599–1602