TY - JOUR
T1 - Diabetes and Progression of Heart Failure
T2 - The Atherosclerosis Risk In Communities (ARIC) Study
AU - Echouffo-Tcheugui, Justin B.
AU - Ndumele, Chiadi E.
AU - Zhang, Sui
AU - Florido, Roberta
AU - Matsushita, Kunihiro
AU - Coresh, Josef
AU - Skali, Hicham
AU - Shah, Amil M.
AU - Selvin, Elizabeth
N1 - Funding Information:
The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). Dr Echouffo-Tcheugui was supported by NIH/NHLBI grant K23 HL153774. Dr Ndumele was supported by NIH grant R01HL146907. Dr Shah was supported by NIH/NHLBI grants R01HL135008, R01HL143224, R01HL150342, R01HL148218, and K24HL152008; has received research support not related to this study from Novartis and Philips Ultrasound; and has received consulting fees from Philips Ultrasound and Edwards Lifesciences. Dr Selvin was supported by NIH/NHLBI grant K24 HL152440 and NIH/NIDDK grant R01DK089174; and has received payments from Wolters Kluwer for chapters and laboratory monographs in UpToDate on measurements of glycemic control and screening tests for type 2 diabetes. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/6/14
Y1 - 2022/6/14
N2 - Background: The influence of diabetes on progression from preclinical heart failure (HF) stages to overt HF is poorly understood. Objectives: The purpose of this study was to characterize the influence of diabetes on the progression from preclinical HF stages (A or B based on the 2021 Universal Definition) to overt HF. Methods: We included 4,774 adults with preclinical HF (stage A [n = 1,551] or B [n = 3,223]) who attended the ARIC (Atherosclerosis Risk In Communities) study Visit 5 (2011-2013). Within each stage (A or B), we assessed the associations of diabetes and glycemic control (hemoglobin A1C [HbA1C] <7% vs ≥7%) with progression to HF, and of cross-categories of HF stages (A vs B), diabetes, and glycemic control with incident HF. Results: Among the participants (mean age 75.4 years, 58% women, 20% Black), there were 470 HF events during 8.6 years of follow-up. Stage B participants with HbA1C ≥7% experienced clinical HF at a younger age than those with controlled diabetes or without diabetes (mean age 80 years vs 83 years vs 82 years; P < 0.001). HbA1C ≥7% was more strongly associated with HF in stage B (HR: 1.83; 95% CI: 1.33-2.51) compared with stage A (HR: 1.52; 95% CI: 0.53-4.38). In cross-categories of preclinical HF stage and HbA1C, participants with stage B and HbA1C ≥7% had increased risk of HF progression compared with stage A without diabetes (HR: 7.56; 95% CI: 4.68-12.20). Conclusions: Among older adults with preclinical HF stages, uncontrolled diabetes was associated with substantial risk of HF progression. Our results suggest that targeting diabetes early in the HF process is critical.
AB - Background: The influence of diabetes on progression from preclinical heart failure (HF) stages to overt HF is poorly understood. Objectives: The purpose of this study was to characterize the influence of diabetes on the progression from preclinical HF stages (A or B based on the 2021 Universal Definition) to overt HF. Methods: We included 4,774 adults with preclinical HF (stage A [n = 1,551] or B [n = 3,223]) who attended the ARIC (Atherosclerosis Risk In Communities) study Visit 5 (2011-2013). Within each stage (A or B), we assessed the associations of diabetes and glycemic control (hemoglobin A1C [HbA1C] <7% vs ≥7%) with progression to HF, and of cross-categories of HF stages (A vs B), diabetes, and glycemic control with incident HF. Results: Among the participants (mean age 75.4 years, 58% women, 20% Black), there were 470 HF events during 8.6 years of follow-up. Stage B participants with HbA1C ≥7% experienced clinical HF at a younger age than those with controlled diabetes or without diabetes (mean age 80 years vs 83 years vs 82 years; P < 0.001). HbA1C ≥7% was more strongly associated with HF in stage B (HR: 1.83; 95% CI: 1.33-2.51) compared with stage A (HR: 1.52; 95% CI: 0.53-4.38). In cross-categories of preclinical HF stage and HbA1C, participants with stage B and HbA1C ≥7% had increased risk of HF progression compared with stage A without diabetes (HR: 7.56; 95% CI: 4.68-12.20). Conclusions: Among older adults with preclinical HF stages, uncontrolled diabetes was associated with substantial risk of HF progression. Our results suggest that targeting diabetes early in the HF process is critical.
KW - diabetes
KW - heart failure
KW - outcomes
KW - preclinical heart failure stages
KW - risk
KW - type 2 diabetes
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U2 - 10.1016/j.jacc.2022.03.378
DO - 10.1016/j.jacc.2022.03.378
M3 - Article
C2 - 35680178
AN - SCOPUS:85130890873
SN - 0735-1097
VL - 79
SP - 2285
EP - 2293
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 23
ER -