In HFpEF, diabetes (RR 1.59; 95% CI 1.35-1.88) and pre-diabetes (HR 1.27; 95% CI 1.00-1.60) were associated with a higher risk of CV death and heart failure hospitalizations compared to normal HbA1c.
Cohort (n=4,796)
Does diabetes or pre-diabetes increase the risk of cardiovascular death and heart failure hospitalizations in patients with HFpEF?
In patients with HFpEF, both pre-diabetes and diabetes are common and associated with a progressively higher risk of heart failure hospitalizations and cardiovascular death.
Effect estimate: RR 1.59 (95% CI 1.35-1.88)
AIM: There is an association between heart failure with preserved ejection fraction (HFpEF) and insulin resistance, but less is known about the diabetic continuum, and in particular about pre-diabetes, in HFpEF. We examined characteristics and outcomes of participants with diabetes or pre-diabetes in PARAGON-HF. METHODS AND RESULTS: Patients aged ≥50 years with left ventricular ejection fraction ≥45%, structural heart disease and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) were eligible. Patients were classified according to glycated haemoglobin (HbA1c): (i) normal HbA1c, <6.0%; (ii) pre-diabetes, 6.0%-6.4%; (iii) diabetes, ≥6.5% or history of diabetes. The primary outcome was a composite of cardiovascular (CV) death and total heart failure hospitalizations (HFH). Of 4796 patients, 50% had diabetes and 18% had pre-diabetes. Compared to patients with normal HbA1c, patients with pre-diabetes and diabetes more often were obese, had a history of myocardial infarction and had lower Kansas City Cardiomyopathy Questionnaire scores, while patients with diabetes had more clinical evidence of congestion, but similar NT-proBNP concentrations. The risks of the primary composite outcome (rate ratio RR 1.59, 95% confidence interval CI 1.35-1.88), total HFH (RR 1.67, 95% CI 1.39-2.02) and CV death (hazard ratio HR 1.35, 95% CI 1.07-1.71) were higher among patients with diabetes, compared to those with normal HbA1c. Patients with pre-diabetes had a higher risk (which was intermediate between that of patients with diabetes and those with normal HbA1c) of the primary outcome (HR 1.27, 95% CI 1.00-1.60) and HFH (HR 1.35, 95% CI 1.03-1.77), but not of CV death (HR 1.02, 95% CI 0.75-1.40). Patients with diabetes treated with insulin had worse outcomes than those not, and those with 'lean diabetes' had similar mortality rates to those with a higher body mass index, but lower rates of HFH. CONCLUSION: Pre-diabetes is common in patients with HFpEF and is associated with worse clinical status and greater risk of HFH. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01920711.
Jackson et al. (Fri,) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=4,796). Diabetes and pre-diabetes vs. Normal HbA1c (<6.0%) was evaluated on Composite of cardiovascular (CV) death and total heart failure hospitalizations (HFH) (RR 1.59, 95% CI 1.35-1.88). In HFpEF, diabetes (RR 1.59; 95% CI 1.35-1.88) and pre-diabetes (HR 1.27; 95% CI 1.00-1.60) were associated with a higher risk of CV death and heart failure hospitalizations compared to normal HbA1c.