medwireNews: The presence of diabetes in people with preclinical heart failure (HF) shortens the time to a first clinical event, especially if blood glucose is poorly controlled, show data from the ARIC study.
“Our results suggest that targeting diabetes early in the HF process is critical,” write Justin Echouffo-Tcheugui (Johns Hopkins University, Baltimore, Maryland, USA) and co-researchers in the Journal of the American College of Cardiology.
“There are likely substantial benefits for HF prevention by aggressively treating diabetes as early as possible in the HF disease process, with potentially significant results from an intervention in both stages A and B (in which a structural abnormality is already established).”
A total of 4774 ARIC participants (average age 75.4 years) had evidence of preclinical HF stage A (32.5%) or B (67.5%) at the 2011–2013 study visit, 30% of whom had diabetes.
During a median follow-up of 7.5 years, 470 people had a first HF event. Among people with stage A HF (risk factors but no evidence of structural heart disease), the incidence rate per 1000 person–years was 5.7 in those with diabetes and 3.6 in those without.
HF events were more frequent overall among people with stage B disease (structural heart disease or elevated cardiac biomarkers but no signs or symptoms), and were again more common among people with versus without diabetes, at 25.7 versus 19.0 events per 1000 person–years. Among those with diabetes, the event rate was higher if glycated hemoglobin (HbA1c) was at least 7% (53 mmol/mol) versus lower, at 36.4 versus 21.7 events per 1000 person–years.
Also, the average time to a clinical HF event was shorter in people with stage B versus A HF, at 5.5–6.1 years and 4.0–4.1 years, respectively.
After accounting for confounders including age, sex, race, BMI, kidney function, blood pressure, coronary heart disease, and medications, the presence of diabetes did not influence HF risk in people with stage A disease, regardless of HbA1c level.
But stage B HF, diabetes, and high HbA1c all significantly contributed to the risk for HF events. Compared with having stage A HF and no diabetes, the risk for an event was elevated 4.16-fold in people with stage B HF without diabetes and 5.32-fold for those with diabetes.
However, when assessed according to glycemic control, only the presence of HbA1c of 7% or higher significantly added to the risk associated with having stage B HF, increasing the risk for a first clinical event 1.83-fold. The risk associated with well-controlled diabetes was equivalent to not having the condition.
“The high absolute and relative risks of progression to overt HF associated with diabetes in stage B HF signals the urgent need for intervention in this high-risk group and that prevention of diabetes should be a clinical and public health priority, especially because the observed times to event in our study are consistent with a short preclinical window for intervention,” conclude the researchers.
“The delivery of HF prevention interventions in the primary care setting may be particularly important.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
J Am Coll Cardiol 2022; 79: 2285–2293