Delaying Diabetes Onset a Target for Heart Failure Prevention

By Reuters Staff

August 20, 2021

NEW YORK (Reuters Health) - Efforts to delay the onset of diabetes may be a target for heart failure (HF) prevention, according to new data showing a strong association between diabetes duration and HF risk.

"The results of our study can help refine the assessment of the risk of heart failure among individuals with diabetes, and thus better implement primary and secondary cardiovascular preventive care among individuals at risk for or with diabetes, possibly through a delay of diabetes onset and an aggressive use of cardioprotective therapies among those with longer diabetes duration," researchers write in the Journal of the American College of Cardiology: Heart Failure.

Using data from the ARIC study, Dr. Justin B. Echouffo-Tcheugui of Johns Hopkins University, in Baltimore, Maryland, and colleagues assessed the association of diabetes duration with incident HF among 9,734 adults (mean age, 63 years; 58% women; 22% Black) without HF or coronary heart disease in 1996-1998.

Over 22.5 years of follow-up, 1,968 HF events were recorded. Compared with those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with diabetes for 15 or more years (hazard ratio, 2.82; 95% confidence interval, 2.25 to 3.63).

Each five-year increase in diabetes duration was associated with a 17% (95% CI, 11% to 22%) increase in HF risk.

Longer diabetes duration was more strongly associated with HF risk among younger individuals, among those with poor glycemic control, among Blacks compared with whites, and among women compared with men.

Notably, prediabetes was also associated with an increased risk of HF, the researchers say.

The findings, they add, highlight the importance of accounting for the duration of diabetes when assessing the risk of diabetes-related HF.

"Although some diabetes-specific risk algorithms like the UKPDS (United Kingdom Prospective Diabetes Study) risk prediction tools have included the duration of diabetes in the prediction of atherosclerotic cardiovascular disease (coronary heart disease and stroke), this metric has not yet been taken into account in HF prediction algorithms," they point out.

"Additionally, the integration of the duration of diabetes in HF risk estimation among people with diabetes could help refine the selection of high-risk individuals who may derive the greatest absolute benefits from aggressive cardioprotective preventative therapies, especially novel therapies such as SGLT2 inhibitors," they add.

In addition, the results suggest that delaying the onset of diabetes using strategies similar to those implemented in the U.S. Diabetes Prevention Program may help prevent the onset of HF.

The ARIC study had no commercial funding. The authors have declared no conflicts of interest.

SOURCE Journal of the American College of Cardiology: Heart Failure, online July 26, 2021.