Heart failure poses greatest CV mortality risk after type 2 diabetes diagnosis
medwireNews: Real-world study findings suggest that heart failure (HF) is associated with the greatest increase in mortality risk when compared with other cardiovascular (CV) and renal complications among people with newly diagnosed type 2 diabetes.
Bochra Zareini (University Hospital Herlev and Gentofte, Hellerup, Denmark) and colleagues used Danish nationwide registers to evaluate 5-year death rates among 153,405 adults who were diagnosed with type 2 diabetes between 1998 and 2015 and had no CV or renal disease at baseline.
During a median follow-up of 9.7 years, 69,201 individuals, representing 45.1% of the study population, developed CV or renal disease; of these, 62.3% had one condition, 25.0% two, and 12.6% three or more. Ischemic heart disease (IHD) was the most common diagnosis, impacting 2.4%, 8.2%, and 12.6% of patients at the 1-, 5-, and 10-year follow-up, respectively, while HF was the least common, diagnosed in a corresponding 0.7%, 1.6%, and 2.2% of patients.
Despite being the least common CV complication, HF was associated with the highest 5-year mortality risk among people alive 5 years after being diagnosed with type 2 diabetes, at a rate of 47.6%. By comparison, mortality rates were lower than 35.0% among patients who developed IHD, stroke, chronic kidney disease (CKD), or peripheral artery disease (PAD).
Compared with people with type 2 diabetes who did not develop any CV or renal complications, those with HF had a significant threefold elevated risk for 5-year mortality, while those with other complications had a significant 1.3–2.3-fold increased risk.
Moreover, patients who developed HF lived 11.7 months less, on average, relative to those without complications, while there were smaller decreases in lifespan (1.6–6.9 months) for the other diagnoses, report the researchers in Circulation: Cardiovascular Quality and Outcomes.
When the team analyzed different combinations of CV complications, they found that patients with HF in combination with CKD or stroke had the highest 5-year mortality rates (63.7 and 54.1%, respectively), whereas the rates were “somewhat lower” in those with HF in combination with PAD (48.4%) or IHD (45.5%).
Together, these findings indicate that HF is “clearly associated with the most unfavorable prognosis in patients with [type 2 diabetes],” and highlight “the importance of evaluating patients with [type 2 diabetes] regularly for HF,” say Zareini and team.
The researchers note the beneficial effects of some antidiabetes medications seen in recent CV outcome trials, and caution that their study did not account for sodium-glucose cotransporter inhibitor (SGLT)-2 and glucagon-like peptide-1 receptor agonist use.
However, in a press release, Zareini stressed: “Our study highlights which subgroups of patients need and could benefit most from targeted risk evaluation, prevention and treatment.”
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