Diabetics Develop HF Sooner and Die Younger After HF Than Matched Controls: Fremantle Diabetes Study

June 08, 2015

BOSTON, MA – Patients with type 2 diabetes have nearly a twofold higher prevalence of heart failure when compared with matched controls, according to a new review of data from Western Australia[1].

The prevalence of heart failure among type 2 diabetic patients participating in the Fremantle Diabetes Study (FDS) is less than that observed in other studies of diabetic patients, which has been reported to be as high as four times the general population, but this is likely a reflection of better management of cardiovascular risk factors in this contemporary cohort, according to lead investigator Dr Timothy Davis (University of Western Australia, Fremantle).

The study, which was presented this week here at the American Diabetes Association (ADA) 2015 Scientific Sessions, is an analysis of the first phase of this community-based, observational study. There were 1296 patients with type 2 diabetes recruited into the study between 1993 and 1996 and followed for an average of 12 years. The mean age of patients upon enrollment was 64 years, and patients had a diagnosis of diabetes for 4 years.

In total, 8.6% of subjects had a prior hospitalization for heart failure. In 5159 matched controls without type 2 diabetes, just 3.0% had been hospitalized previously for heart failure, a statistically significant difference compared with the FDS patients.

Of the 1185 individuals without heart failure at baseline, 31.8% were hospitalized for heart failure or died from heart failure during the follow-up period. Compared with the controls, those with type 2 diabetes were more than two times more likely to develop heart failure (hazard ratio 2.36; 95% CI 2.09–2.66) during the 12-year follow-up.

In addition to the established risk factors for heart failure, Davis said renal hyperfiltration—defined as an estimated glomerular filtration ratio (eGFR) >90 mL/min—was identified in Cox proportional hazard modeling as a potentially novel risk factor for developing heart failure.

Diabetic Patients Get Heart Failure Earlier, Die Earlier

To heartwire from Medscape, Davis said the novel finding from their review is that "diabetic patients have their first heart-failure event 4 to 5 years before individuals without diabetes, and they die 4 years earlier after their heart-failure event."

In the analysis, diabetic patients presented, on average, at age 75 years with their first heart-failure hospitalization compared with 80 years in the age- and sex-matched control arm. The age of death among diabetic patients following the first heart-failure event was 79 years in the FDS patients vs 83 years among nondiabetic patients who developed heart failure.

Davis said that while heart failure is now a recognized complication from type 2 diabetes, he suggests that physicians treating these patients aggressively manage cardiovascular risk factors and keep an eye on heart function.

"Shortness of breath in type 2 diabetes might be chalked up to poor fitness or being overweight," said Davis. "Heart failure might not be suspected and missed clinically. But as this study shows, it is a very common complication—30% of type 2 diabetics went on to develop or die from heart failure."

The Raine Foundation and the University of Western Australia funded the Fremantle Diabetes Study.


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