Heart failure particularly high risk in type 1 diabetes patients
medwireNews: The likelihood of dying during or soon after heart failure hospitalization is higher among patients with type 1 than type 2 diabetes, report researchers.
Patients with type 2 diabetes were no more likely than those without diabetes to die within 30 days after heart failure hospitalization. By contrast, the risk was increased by 31% for women with type 1 diabetes and 91% for men, after accounting for age, sex, and deprivation.
This finding “provides additional support for the view that heart failure is an under-recognised and important complication in type 1 diabetes,” say David McAllister (University of Glasgow, UK) and study co-authors.
Moreover, the team found that type 1 diabetes patients were less likely than type 2 diabetes patients to be prescribed medications that can directly or indirectly reduce the risk for heart failure. This difference remained statistically significant for a range of medications, including thiazides, beta blockers, calcium channel blockers, and drugs acting on the renin–angiotensin system, but not for loop diuretics, after accounting for age, sex, and risk factors for heart failure.
The researchers caution that the variables used were obtained from national databases, rather than being gathered prospectively, and were not always complete.
“Nonetheless, this observation does raise the possibility that, even where the heart failure risk is similar, people with type 1 diabetes may be less likely than people with type 2 diabetes to receive preventative drug therapy,” they write in Circulation.
The study encompassed 3.25 million people resident in Scotland. Between 2004 and 2013, there were 91,429 heart failure hospitalizations among people without diabetes as well as 1313 and 22,959 among those with type 1 and type 2 diabetes, respectively. As with case-fatality, incidence varied with age and sex. It was higher in people with diabetes, especially those with type 1 diabetes.
The effects of diabetes on heart failure hospitalization risk were largest, relatively speaking, in women and younger people, but the researchers stress that overall rates were higher in older people and men. “Therefore, from the perspective of the individual patient, the impact of diabetes on heart failure risk is greater at older ages and in men,” they say.
The rate of heart failure hospitalization declined slightly during the study period, at 0.2% per year overall, with the annual decline being steeper in older people, by 0.5% per 10-year increase in age. Of note, the decline was also steeper in patients with type 1 diabetes, at 2.1% per year.
Likewise, there was a decline in case-fatality, by 3.3% per year, although for this there were no differences between people with and without diabetes.
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