Key result
In individuals with diabetes, high triglycerides were associated with an increased risk of incident heart failure (HR 3.59; 95% CI 2.03-6.33), an association partly mediated by myocardial infarction.
Why the study?
Are lipid levels associated with incident heart failure in adults with and without diabetes mellitus?
Cohort (n=5,688)
Are lipid levels associated with incident heart failure in adults with and without diabetes mellitus?
Hazard Ratio: 3.59 (95% CI 2.03–6.33)
Dyslipidemia, specifically high triglycerides and low HDL-C, is strongly associated with incident heart failure in patients with diabetes, but not in those without diabetes.
Supports HF risk stratification by triglycerides in diabetes; leaves open whether lowering them reduces incidence.
BACKGROUND: Dyslipidemia is a known risk factor for coronary disease, but its role in heart failure (HF) development is less well-defined. METHODS AND RESULTS: We included 5688 participants, aged 45 to 84 years, without clinical cardiovascular disease, and not receiving lipid-lowering medications at baseline, from the Multiethnic Study of Atherosclerosis. Cox-proportional hazards models were used to evaluate associations of triglyceride, total cholesterol/high-density lipoprotein-cholesterol (HDL-C) ratio, HDL-C, and non HDL-C with incident HF. We investigated for effect-modification by diabetes mellitus status and sex. During a median follow-up of 8.5 years, there were 152 incident HF cases. There were no interactions by sex. We observed significant interactions between triglyceride and diabetes mellitus (P(interaction)<0.05). We stratified our analyses by diabetes mellitus status. In participants with diabetes, the hazard ratios were 2.03 (0.97-4.27) and 1.68 (1.18-2.38) for high triglyceride and log of triglyceride, respectively, after adjusting for confounders, comorbidities, and diabetes mellitus severity/treatment. The association of high triglyceride with incident HF was attenuated by interim myocardial infarction. The hazard ratios were greatest in participants with diabetes who also had high triglyceride, low HDL-C, or high total cholesterol/HDL-C ratio (3.59 [2.03-6.33], 3.62 [2.06-6.36], and 3.54 [1.87-6.70], respectively). Lipid measures were not associated with incident HF in individuals without diabetes. CONCLUSIONS: The risk of incident HF is greater in individuals with diabetes mellitus who also have high triglyceride, low HDL-C, or high total cholesterol/HDL-C ratio. The association of high triglyceride with incident HF is partly mediated by myocardial infarction.
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Ebong et al. (2013) conducted a cohort in Incident heart failure (n=5,688). High triglyceride, low HDL-C, or high total cholesterol/HDL-C ratio vs. Normal lipid levels was evaluated on Incident heart failure (HR 3.59, 95% CI 2.03-6.33). In individuals with diabetes, high triglycerides were associated with an increased risk of incident heart failure (HR 3.59; 95% CI 2.03-6.33), an association partly mediated by myocardial infarction.
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