Early detection and optimal management of cardiorenal metabolic syndrome to prevent heart failure in the population with coronary heart disease: results from INTERASPIRE survey

Background Heart failure (HF) impacts quality of life with substantial economic consequences. Cardiorenal metabolic syndrome (CRMS) defined as an aggregation of coronary heart disease (CHD), chronic kidney disease (CKD), and metabolic syndrome markedly elevates HF risk. Contemporary international data are lacking on how common CRMS is among patients with CHD. Purpose To describe prevalence of CRMS and/or HF in patients with CHD in 13 countries from all 6 World Health Organization (WHO) regions and determine opportunities to optimise heart failure prevention through management of CRMS. Methods Between 2020 and 2023, adults hospitalized in the preceding 6–24 months with incident or recurrent CHD were recruited into the INTERASPIRE study, invited for standardized interview, examination and central laboratory measurements, with follow-up 1 year after recruitment. HF was defined as one of; clinical HF or LVEF <50% during index hospitalization, prescription for furosemide, Sacubitrol/Valsartan, or SGLT2i in the absence of CKD or diabetes, or elevated BNP/NTproBNP (>35pg/mL/>125pg/mL) with tiredness or shortness of breath recorded at interview. CRMS defined as CHD with metabolic syndrome (three of - central obesity [waist circumference ≥102cm men, ≥88cm women], dysglycaemia [FPG ≥ 5.6 mmol/L and/or medication], hypertension [≥130/85mmHg and/or medication], elevated triglycerides [≥1.7mmol/L and/or medication] or reduced HDL cholesterol [≥ 1.0mmol/L men, ≥ 1.3mmol/L women and/or medication]) and CKD (history of CKD or eGFR < 60 mg/min/1.73m²). Direct age- and sex-standardization with overall population as reference used for country-level prevalence estimation. Results Among 4259 patients, mean age 60.2 (10.3) years, 21% women. Prevalence of HF/CRMS was 9.6% (4.1% - 20.2%). Prevalence of CHD without HF/CRMS was 55.4% (37.5% - 59.4%). Compared to the population without HF/CRMS, those living with CRMS and HF were more likely to be older (59.2 vs 65.1 years), rehospitalized with CVD (5.6% vs 15%) or die from any cause (0.9% vs 6.6%) at follow-up. Among the population with CHD but without HF/CRMS, 58% had metabolic syndrome, 4.6% had CKD. Among these, 35% had central obesity, 44.6% had eGFR below 90 mL/min/1.73m2, 30% had high tryglcerides,17% were current smokers, 60% were not achieving physical activity targets,18% were eligible for GLP 1-RA based on SELECT trial criteria. In participants receiving preventive treatments, achievement of risk factor targets was uncommon– hypertension (33% with BP<130/80 mmHg), diabetes (16% with HbA1c< 7%) and dyslipidaemia (20% with LDL-C <1.4 mmol/L). Conclusion Prevention of HF requires early lifestyle intervention, risk factor control and optimal pharmacotherapy. Opportunities exist to prevent development of CRMS and/or HF. An integrated, multidisciplinary approach to manage total cardiovascular risk associated with diagnosed / undiagnosed CRMS is compelling.