Why the study?
Heart failure is increasingly recognized as a common first presentation of CV disease in type 2 diabetes, but whether HHF occurs more or less frequently than MACE was undetermined.
Does hospitalization for heart failure occur more or less frequently than major adverse CV events in people with type 2 diabetes?
Does hospitalization for heart failure occur more or less frequently than major adverse CV events in people with type 2 diabetes?
Hospitalization for heart failure is a common event in type 2 diabetes, occurring less frequently than MI but more frequently than stroke, regardless of prior CV disease.
HHF ranks among top nonfatal CV events in T2D; leaves open whether HF-focused prevention warrants dedicated trials or guideline priority.
BACKGROUND Emerging evidence points to heart failure as being a common first presentation of cardiovascular (CV) disease in type 2 diabetes. PURPOSE The purpose of this study was to determine whether hospitalization for heart failure (HHF) occurs more or less frequently than major adverse CV events (MACE) in people with type 2 diabetes. DATA SOURCES Placebo arms of CV outcomes trials in type 2 diabetes were included. STUDY SELECTION Sixteen CV outcomes trials were selected, including five dipeptidyl peptidase 4 inhibitor trials, seven glucagon-like peptide 1 receptor agonist trials, and four sodium–glucose cotransporter 2 inhibitor trials. DATA EXTRACTION We extracted incidence rates of HHF, myocardial infarction (MI), stroke, and the composite outcomes of CV death or HHF and MACE (CV death, nonfatal MI, or nonfatal stroke). DATA SYNTHESIS In two trials enriched with people with chronic kidney disease, HHF was more common than both MI and stroke. Among the remaining 14 trials, HHF was less frequent than MI in 13 (93%), with this difference being significant in 8 (57%); however, HHF surpassed stroke in all but 1 study (93%; significant in 7 studies [50%]). Heterogeneity among trials was moderate/high (I2 >50%) and partly explained by HHF/MI correlating with age and previous MI history (P < 0.05). In seven trials that reported events stratified by presence/absence of preexisting CV disease, ratios of HHF/MI and HHF/stroke were similar between groups. LIMITATIONS Enrichment of trial populations with those at high risk of CV events limits generalizability. CONCLUSIONS Although less frequent than MI, HHF is a common event in type 2 diabetes, both in those with and those without prior CV disease.
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Sacre et al. (2020) studied this question.
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