Prediction of heart failure as the first major cardiovascular disease event in type 2 diabetes

Abstract Aims Heart failure (HF) may develop in type 2 diabetes without prior cardiovascular disease (CVD). This study aimed to identify risk factors that distinguish CVD that presents first as a HF event versus CVD that presents first as an atherosclerotic event (ASCVD), among people with type 2 diabetes. Materials and methods ORIGIN and REWIND trial participants with type 2 diabetes but free of CVD ( N = 6175; 64 ± 7 years, 50.1% female) were followed for ~5.8 years for incident CVD presenting first as either a HF event (HF hospitalization or HF death), ASCVD (myocardial infarction, unstable angina, stroke, or revascularization), or other cardiovascular death. Multi‐state models characterised event‐specific associations of risk factors with each possible first CVD event. Results HF was the first event in 16.8% of 1024 incident CVD cases. Older age, higher BMI, and higher urine albumin:creatinine ratio were more strongly associated with CVD manifesting first as HF, rather than as ASCVD or other cardiovascular death. ASCVD as the first event (65.2% of cases) was more strongly associated with worse LDL‐cholesterol and HbA1c. These unique associations of risk factors with HF versus ASCVD translated to variable probabilities of HF as the first CVD event, depending on the clinical profile (32.0% for a profile enriched with HF‐specific risk factors versus 5.1% for a profile enriched with ASCVD‐specific risk factors). Conclusions CVD that presents first as a HF event is common in type 2 diabetes and its risk factors are distinct from those associated with CVD that presents first as an ASCVD event.