Known diabetes increased heart failure risk by HR 2.62 (95% CI 2.18-3.12), while prediabetes was not associated with significantly higher heart failure risk after adjustment.
Does prediabetes or diabetes increase the risk of new onset heart failure in individuals without prior heart failure or ischemic heart disease?
While known diabetes is a strong independent risk factor for incident heart failure, the previously reported association between prediabetes and heart failure appears to be driven by confounding factors such as BMI and blood pressure.
Absolute Event Rate: 0% vs 0%
Abstract Background Diabetes is a well-recognized risk factor for heart failure (HF) and atherosclerotic cardiovascular disease. Prediabetes, defined as either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), has not been as thoroughly studied. Many previous studies are limited by either a highly selected study sample or incomplete adjustment for potential confounding, and only very few studies have performed oral glucose tolerance tests to adequately assess glycemic status. Methods We conducted a prospective population-based cohort study with participants from the Västerbotten Intervention Programme (VIP) and the The Northern Sweden Monica Project (MONICA), including a total of 172 817 observations from 110 157 unique individuals. Participants with previous HF and ischemic heart disease (IHD) were excluded at baseline. All participants underwent fasting glucose and oral glucose tolerance testing, and were stratified into six groups depending on their glycemic status. HF was assessed through the Swedish national patient register and the cause of death register, with 100% national coverage and excellent sensitivity for HF diagnosis. Cox proportional hazard model was used to calculate the HRs of developing HF among diabetic and prediabetic states with normoglycemic individuals considered as reference, step-wise adjusted for potential confounding at different levels. Results A total of 3263 (3.0%) new onset HF were identified during a mean follow-up of 12.7 (SD 7.8) years. In unadjusted analyses, there was an approximate two-fold increase in risk of HF among people with prediabetes, and a five-fold increase in people with known diabetes at baseline. Adjustment for age, sex and BMI, as causal ancestors of diabetes, attenuated the association, and further adjustment for blood pressure and total cholesterol, as confounding risk factors with common ancestors, as well as socioeconomic data, eliminated the association between prediabetes and newly diagnosed diabetes and HF. Previously known diabetes still conveyed a significantly increased risk (HR 2.62 95 % CI 2.18-3-12), which was more pronounced at young age, and less so at older age. No interaction was found across BMI categories. Conclusion When adjusting for relevant covariates, diabetes was associated with significantly increased risk of HF compared to normoglycemic individuals. Prediabetes was not associated with a significantly higher risk of HF compared to normoglycemic individuals, indicating that much of the previously reported association may be due to confounding. This highlights the potential for primary preventive efforts aiming at weight management and blood pressure control in people with diabetes to prevent the development of HF.
Reinert et al. (Sat,) reported a other. Known diabetes increased heart failure risk by HR 2.62 (95% CI 2.18-3.12), while prediabetes was not associated with significantly higher heart failure risk after adjustment.