TY - JOUR
T1 - Glycemic Markers and Heart Failure Subtypes
T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)
AU - Echouffo-Tcheugui, JUSTIN B.
AU - OGUNMOROTI, OLUSEYE
AU - GOLDEN, SHERITA H.
AU - BERTONI, ALAIN G.
AU - MONGRAW-CHAFFIN, MORGANA
AU - PANDEY, AMBARISH
AU - NDUMELE, CHIADI E.
AU - MICHOS, ERIN D.
N1 - Funding Information:
The MESA study is supported by contracts 75N92020D00001, HHSN268201500003I, N01‐HC‐95159, 75N92020D00005, N01‐HC‐95160, 75N92020D00002, N01‐HC‐95161, 75N92020D00003, N01‐HC‐95162, 75N92020D00006, N01‐HC‐95163, 75N92020D00004, N01‐HC‐95164, 75N92020D00007, N01‐HC‐95165, N01‐HC‐95166, N01‐HC‐95167, N01‐HC‐95168, and N01‐HC‐95169 from the NIH/NHLBI, and by grants KL2TR001424, UL1‐TR‐000040, UL1‐TR‐001079, and UL1‐TR‐001420 from the National Center for Advancing Translational Sciences. The funding agencies had no role in the formulation, editing, or decision to submit this article.
Funding Information:
Supported by an American Heart Association Strategic Focused Network grant 20SFRN35120152 . Dr Echouffo Tcheugui was supported by NIH/NHLBI grant K23 HL153774 . Dr Ndumele was supported by NIH grant R01HL146907 and AHA grant 20SFRN35120152 . Dr Michos was supported by the Amato Fund in Women's Cardiovascular Health at Johns Hopkins University.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/11
Y1 - 2022/11
N2 - Background: Although diabetes increases heart failure (HF) risk, it is unclear how various dysglycemia markers (hemoglobin A1C [HbA1C], fasting plasma glucose [FPG], homeostasis model assessment of insulin resistance, and fasting insulin) are associated with HF subtypes (HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction [HFrEF]). We assessed the relation of markers of dysglycemia and risks of HFpEF and HFrEF. Methods and Results: We included 6688 adults without prevalent cardiovascular disease who attended the first MESA visit (2000–2002) and were followed for incident hospitalized HF (HFpEF or HFrEF). Association of glycemic markers and status (normoglycemia, prediabetes, diabetes) with HFpEF and HFrEF were evaluated using adjusted Cox models. Over a median follow-up of 14.9 years, there were 356 HF events (145 HFpEF, 173 HFrEF, and 38 indeterminate HF events). Diabetes status conferred higher risks of HFpEF (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.57–2.68) and HFrEF (HR 2.02, 95% CI 1.38–2.97) compared with normoglycemia. Higher levels of FPG (≥126 mg/dL) and HbA1C (≥6.5%) were associated with similarly higher risks of HFpEF (HR for FPG 1.96, 95% CI 1.21–3.17; HR for HbA1C 2.00, 95% CI 1.20–3.31) and HFrEF (HR for FPG 1.84, 95% CI 1.18–2.88; HR for HbA1C 1.99, 95% CI 1.28–3.09) compared with reference values. Prediabetic range HbA1C (5.7%–6.4%) or FPG (100%–125 mg/dL), homeostasis model assessment of insulin resistance, and fasting insulin were not significantly associated with HFpEF or HFrEF. Conclusions: Among community-dwelling individuals, HbA1C and FPG in the diabetes range were each associated with higher risks of HFpEF and HFrEF, with similar magnitudes of their associations. Lay Abstract: Heart failure (HF) has 2 major subtypes (the heart's inability to pump or to fill up). Diabetes is known to increase HF risk, but its effects and that of markers of high glucose levels (fasting blood glucose and hemoglobin A1C) on the occurrence of HF subtypes remains unknown. Among 6688 adults without known cardiovascular disease followed for nearly 15 years, diabetes conferred significantly higher risks of both HF types, compared with those with normal blood glucose levels. Higher levels of fasting blood glucose and hemoglobin A1C were similarly associated with higher risks of both types of HF.
AB - Background: Although diabetes increases heart failure (HF) risk, it is unclear how various dysglycemia markers (hemoglobin A1C [HbA1C], fasting plasma glucose [FPG], homeostasis model assessment of insulin resistance, and fasting insulin) are associated with HF subtypes (HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction [HFrEF]). We assessed the relation of markers of dysglycemia and risks of HFpEF and HFrEF. Methods and Results: We included 6688 adults without prevalent cardiovascular disease who attended the first MESA visit (2000–2002) and were followed for incident hospitalized HF (HFpEF or HFrEF). Association of glycemic markers and status (normoglycemia, prediabetes, diabetes) with HFpEF and HFrEF were evaluated using adjusted Cox models. Over a median follow-up of 14.9 years, there were 356 HF events (145 HFpEF, 173 HFrEF, and 38 indeterminate HF events). Diabetes status conferred higher risks of HFpEF (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.57–2.68) and HFrEF (HR 2.02, 95% CI 1.38–2.97) compared with normoglycemia. Higher levels of FPG (≥126 mg/dL) and HbA1C (≥6.5%) were associated with similarly higher risks of HFpEF (HR for FPG 1.96, 95% CI 1.21–3.17; HR for HbA1C 2.00, 95% CI 1.20–3.31) and HFrEF (HR for FPG 1.84, 95% CI 1.18–2.88; HR for HbA1C 1.99, 95% CI 1.28–3.09) compared with reference values. Prediabetic range HbA1C (5.7%–6.4%) or FPG (100%–125 mg/dL), homeostasis model assessment of insulin resistance, and fasting insulin were not significantly associated with HFpEF or HFrEF. Conclusions: Among community-dwelling individuals, HbA1C and FPG in the diabetes range were each associated with higher risks of HFpEF and HFrEF, with similar magnitudes of their associations. Lay Abstract: Heart failure (HF) has 2 major subtypes (the heart's inability to pump or to fill up). Diabetes is known to increase HF risk, but its effects and that of markers of high glucose levels (fasting blood glucose and hemoglobin A1C) on the occurrence of HF subtypes remains unknown. Among 6688 adults without known cardiovascular disease followed for nearly 15 years, diabetes conferred significantly higher risks of both HF types, compared with those with normal blood glucose levels. Higher levels of fasting blood glucose and hemoglobin A1C were similarly associated with higher risks of both types of HF.
KW - Diabetes
KW - fasting glucose
KW - glycosylated hemoglobin
KW - heart failure subtypes
KW - insulin resistance
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U2 - 10.1016/j.cardfail.2022.01.011
DO - 10.1016/j.cardfail.2022.01.011
M3 - Article
C2 - 35114382
AN - SCOPUS:85126056249
SN - 1071-9164
VL - 28
SP - 1593
EP - 1603
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 11
ER -