Heart Failure Epidemiology in Patients With Diabetes Mellitus Without Coronary Heart Disease |
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Authors: | Hassan Khan Stefan D. Anker James L. Januzzi Darren K. McGuire Naveed Sattar Hans Juergen Woerle Javed Butler |
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Affiliation: | 1. Cardiology Division, Emory University, Atlanta, Georgia, United States;2. Division of Cardiology and Metabolism—Heart Failure, Cachexia, and Sarcopenia, Department of Cardiology (CVK), and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine, Berlin, Germany;3. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States;4. Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas, United States;5. BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom;6. Boehringer Ingelheim Pharma and Co. KG, Ingelheim, Germany;7. Cardiology Division, Stony Brook University, Stony Brook, New York, United States |
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Abstract: | BackgroundEpidemiology of patients with comorbid heart failure (HF) and diabetes mellitus (DM) without coronary heart disease (CHD) is not well described.Methods and ResultsWe assessed HF incidence and outcomes in 2896 participants of the Health ABC Study (age 74.0 ± 3.0 years, 48.4% men, 41.1% black, 34.6% with DM) in relation to prio DM and CHD status. During a median follow-up of 11.4 years, 484 participants (16.7%) developed incident HF; 214 (44.2%) had DM of whom 71 (33.1%) had no prio CHD. Incident HF rate was 2.5% per 100 person-years in those with and 1.5% in those without DM (hazard ratio [HR] 1.66, 95% CI 1.39–1.99). In those with DM, incident HF rate was 4.6% in those with and 1.3% in those without CHD (HR 3.75, 95% CI 2.81–4.99). During a median follow-up of 2.1 years after HF onset, 329 (68.0%) of the participants died. Amongst those with DM, annual mortality was 22.6% in those with versus 25.9% without CHD (HR 0.86, 95% CI 0.61–1.22). All-cause hospitalizations after incident HF in DM patients were 55.0 per 100 person-years in those with and 33.3 in those without CHD (rate ratio [RR] 1.64, 95% CI 1.24–2.16); HF hospitalizations were 42.7 and 30.7 per 100-person years (RR 1.39, 95% CI 1.03–1.86) in those with and without CHD. Reduced ejection fraction was seen in 49.6% of HF patients with DM and CHD and in 34.7% of those without CHD (P?=?.08); mortality but not hospitalization risk tended to be lower in those with reduced compared with preserved ejection fraction regardless of CHD status.ConclusionsA sizeable proportion of HF in patients with DM develops in the absence of prior CHD; these patients are at risk for mortality similar to those with CHD. These data underscore the importance of modulating risk beyond atherosclerosis in patients with comorbid HF and DM. |
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Keywords: | Heart failure diabetes mellitus epidemiology outcomes mortality hospitalization ejection fraction |
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