Type 2 Diabetes and Ischemic vs. Nonischemic Heart Failure

Study Questions:

What is the impact of type 2 diabetes mellitus (T2DM) on prognosis in ischemic versus nonischemic heart failure?

Methods:

Using participants in the Swedish Heart Failure Registry (SwedeHF), 35,163 patients were stratified based on presence of T2DM, ischemic (IHD) and nonischemic heart failure, and previous revascularization. Differences in mortality by IHD status and revascularization were estimated using the Cox proportional hazards model. Univariate and multivariate models were used to evaluate the predictive value of T2DM on mortality.

Results:

Among patients with IHD, those with T2DM tended to be younger, and to have a higher prevalence of hypertension and chronic kidney disease. Those with IHD and T2DM were more likely to have New York Heart Association class III or IV compared to those without T2DM; 88% of patients with T2DM and non-IHD had at least one comorbid condition associated with HF. Among patients with IHD, those with T2DM were more likely to have been revascularized. The combination of T2DM and IHD conferred a significantly worse mortality compared to the other subgroups, with an event rate of 50% in those with T2DM and IHD. T2DM was an independent predictor of mortality regardless of the presence of IHD and previous revascularization. This relationship persisted after adjustment. Revascularization was associated with a better survival among both T2DM (adjusted hazard ratio [AHR], 0.82; 95% confidence interval [CI], 0.75-0.91) and non-T2DM (AHR, 0.89; 95% CI, 0.83-0.96).

Conclusions:

T2DM is associated with higher risk of mortality in patients with ischemic and nonischemic heart failure, and IHD in T2DM conferred the worst prognosis. Previous revascularization is associated with better survival in both T2DM and non-T2DM. Patients with T2DM and nonischemic HF have a higher prevalence of HF-related comorbid conditions.

Perspective:

In this study, T2DM was shown to be a predictor of mortality in both ischemic and nonischemic heart failure, although the presence of IHD with T2DM appeared to have the worst outcome. Revascularization appears to favorably impact outcomes in this population. Interestingly, almost 90% of patients with nonischemic HF and T2DM had a potentially modifiable comorbid condition. Efforts should be directed at targeting this group for preventive therapies and elucidating mechanisms in the small population who may have a diabetes-associated cardiomyopathy.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Hypertension

Keywords: Cardiomyopathies, Comorbidity, Diabetes Mellitus, Type 2, Diabetic Cardiomyopathies, Heart Failure, Hypertension, Ischemia, Myocardial Revascularization, Prognosis, Secondary Prevention


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