Heart Failure After Recent T2D Diagnosis Poses Highest Mortality Risk

Heart failure yields the greatest 5-year mortality risk for individuals newly diagnosed with type 2 diabetes (T2D) compared with any other heart or kidney diseases, according to a study published in Circulation: Cardiovascular Quality and Outcomes.

After results from randomized controlled trials found sodium-glucose cotransporter 2 (SGLT2) inhibitors reduced cardiovascular death and heart failure hospitalization, heart failure has become an important clinical endpoint in T2D trials.

However, participants “are often enrolled with a long duration of diabetes mellitus and considered high-risk subjects, and the risk profile following a cardiovascular or renal diagnosis in real-life patients with newly diagnosed T2D remains unknown,” authors wrote.

To address this discrepancy, researchers collected data of patients with incident T2D age 18 or older from 4 nationwide registers in Denmark. Classification of T2D was based on a first-time redeemed prescription of a noninsulin antidiabetic drug.

Between January 1998 and December 2015, 153,405 individuals were newly diagnosed with T2D and had no prior cardiovascular or renal disease diagnoses. These diseases included heart failure, ischemic heart disease (IHD), stroke, chronic kidney disease (CKD), and peripheral artery disease (PAD).

At the time of inclusion, individuals were more likely to be diagnosed with hypertension. However, atrial fibrillation, cancer, and chronic obstructive pulmonary disease were present in less than 5% of the cohort at inclusion.

During a median follow-up period of 9.7 years (interquartile range [IR] 5.8-13.9) the average number of cardiovascular or renal diagnoses per patient was 0.7. During this time, a total of 69,201 patients (45.1%) were diagnosed with either a renal or cardiovascular disease.

The analysis revealed:

• IHD (0.6%-8.0% of all patients) and heart failure (0.4%-4.5% of all patients) were the most common combination of diagnoses within 10 years of T2D diagnosis
• Stroke, CKD, and PAD were present among 0.1% to 3.1% of all patients within 10 years of T2D diagnosis
• The highest 5-year risk of death among patients alive 5 years after T2D diagnosis was found among those who had developed heart failure (47.6% [95% CI, 44.8-50.3]) compared with <35% for individuals who developed IHD, stroke, CKD, and PAD
• The 5-year risk ratio (RR) of death of patients who developed heart failure within 5 years T2D onset was 3 times higher (95% CI, 2.9-3.1) than that of patients without cardiovascular and renal disease
• Patients who developed heart failure within 5 years after diagnosis of T2D lived on average 11.7 months less than patients free of cardiovascular and renal disease (95% CI, 11.6-11.8)
• The highest risks of death 5 years after T2D diagnosis were found in patients who had heart failure in combination with stroke (54.1% [95% CI, 44.7-63.5]) or CKD (63.7% [95% CI, 53.7-73.7])

Because researchers did not have access to echocardiographic measurements and cannot be fully certain of heart failure etiology, the authors warned the findings must be interpreted with caution. Furthermore, treatment effects of different antidiabetic drugs were not covered in the study, and future research could investigate different drugs’ effects on certain risk profiles for a more personalized approach in diabetes management.

“Although not the most frequent complication, heart failure was clearly associated with the most unfavorable prognosis in patients with T2D,” the authors concluded. “When providing care for patients with T2D, we hope that our findings contribute to assessing risk profiles and prognosis, especially concerning the importance of evaluating patients with T2D regularly for heart failure.”

Reference:

Zareini B, Blanche P, D’Souza M, et al. Type 2 diabetes mellitus and impact of heart failure on prognosis compared to other cardiovascular diseases. Circ Cardiovasc Qual Outcomes. 2020;13:e006260. doi:10.1161/CIRCOUTCOMES.119.006260