Excess risk of hospitalisation for heart failure among people with type 2 diabetes

Rosengren, Annika; Edqvist, Jon; Rawshani, Araz; Sattar, Naveed; Franzén, Stefan; Adiels, Martin; Svensson, Ann‐Marie; Lind, Marcus; Guðbjörnsdóttir, Soffia

doi:10.1007/s00125-018-4700-5

Cited by 32 publications

(30 citation statements)

References 24 publications

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“…Of the 5991 articles identified by the systematic search, 760 articles qualified for full-text evaluation, and 14 articles provided summary data for sex differences in the association between diabetes and the risk of heart failure [5,[15][16][17][18][19][20][21][22][23][24][25][26][27] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…NHANES I Epidemiologic Follow-up Study [15] Taiwan's NHI system [19] CALIBER programme [5] Swedish NDR [20] Policardo et al [23] CHS [24] NHS Information Services Scotland [18] KPMCP [26] Kaiser Permanente Georgia [17] LRPP [25] APCSC [16] Subtotal (I 2 = 0.0%, p = 0.834) [8]. Future large-scale individual participant data meta-analysis and mechanistic studies might elucidate this difference.…”

Section: Typementioning

confidence: 99%

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Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

et al. 2019

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Aims/hypothesis The prevalence of diabetes and heart failure is increasing, and diabetes has been associated with an increased risk of heart failure. However, whether diabetes confers the same excess risk of heart failure in women and men is unknown. The aim of this study was to conduct a comprehensive systematic review with meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes. Our null hypothesis was that there is no such sex difference. Methods A systematic search was conducted in PubMed for population-based cohort studies published between January 1966 and November 2018. Studies were selected if they reported sex-specific estimates of RRs for heart failure associated with diabetes, and its associated variability, which were adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes. Results Data from 47 cohorts, involving 12,142,998 individuals and 253,260 heart failure events, were included. The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI 3.43, 7.74) in women and 3.47 (2.57, 4.69) in men, leading to an RRR of 1.47 (1.44, 1.90). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (1.70, 2.22) in women and 1.74 (1.55, 1.95) in men, with a pooled RRR of 1.09 (1.05, 1.13). Conclusions/interpretation The excess risk of heart failure associated with diabetes is significantly greater in women with diabetes than in men with diabetes. PROSPERO registration: CRD42019135246

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Section: Resultsmentioning

confidence: 99%

Section: Typementioning

confidence: 99%

Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

et al. 2019

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“…Although one should be cautious to make direct comparisons between different studies, it is of interest to notice that the excess risk of heart failure [20], major coronary heart events [21] and stroke [22] has been evaluated in individuals with type 2 diabetes compared to controls from similar cohorts as the current based on the Swedish Diabetes Register. Current together with earlier results therefore give indications how incidences and relative risks differ for various cardiovascular complications.…”

Section: Discussionmentioning

confidence: 99%

“…Current together with earlier results therefore give indications how incidences and relative risks differ for various cardiovascular complications. Among individuals with type 2 diabetes, 11.9 cases per 1000 person-years were hospitalized with a diagnosis of heart failure, compared with [20]. The rates of coronary heart disease (CHD) events were 14.6 cases per 1000 person-years among patients with type 2 diabetes versus 8.7 cases per 1000 person-years among controls [21].…”

Section: Discussionmentioning

confidence: 99%

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

Ahmadi

Svensson

Pivodic

et al. 2020

Cardiovasc Diabetol

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Background: To examine the incidence of atrial fibrillation in individuals with type 2 diabetes compared with ageand sex-matched controls from the general population and its variation in relation to glycaemic control and renal function. Methods:A total of 421,855 patients with type 2 diabetes from the Swedish National Diabetes Registry and 2,131,223 controls from the Swedish Population Registry, matched for age, sex and county, were included and followed from Results: Overall, 8.9% of individuals with type 2 diabetes and 7.0% of controls were diagnosed with atrial fibrillation during follow-up, unadjusted incidence risk ratio (IRR) 1.35 (95% 1.33-1.36). Women < 55 years old with type 2 diabetes had an IRR of 2.36 (95% CI 2.10-2.66), in relation to controls, whereas the corresponding value for men < 55 years old with type 2 diabetes was IRR 1.78 (95% CI 1.67-1.90). In the fully adjusted Cox regression, the risk of type 2 diabetes on incident atrial fibrillation was 28% greater vs controls, hazard ratio (HR) 1.28 (95% CI 1.26-1.30), p < 0.0001. The excess risk of atrial fibrillation in individuals with type 2 diabetes increased with worsening glycaemic control and renal complications. For individuals with HbA1c ≤ 6.9% (≤ 52 mmol/mol) and normoalbuminuria the excess risk vs controls was still increased, adjusted HR 1.16 (95% CI 1.14-1.19); p < 0.0001. Conclusions:Individuals with type 2 diabetes had an overall 35% higher risk of atrial fibrillation compared to ageand sex-matched controls from the general population. The excess risk for atrial fibrillation increased with renal complications or with poor glycaemic control. Individuals with type 2 diabetes with good glycaemic control and normoalbuminuria had slightly increased risk.

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“…Figure 1 is a forest plot of the RR for new-onset HF in participants with DM compared with those without DM. Of the 69 included studies, 13 studies 32,35,36,38,44,50,60,65,80,84,[88][89][90] presented data on RR by gender; of these, seven studies 32,35,50,87- Figure 2A is a forest plot of seven studies [28][29][30][31]34,42,55 that examined HFpEF and eight studies [28][29][30][31]34,42,55,56 that examined HFrEF risk in relation to DM. The RR (95% CI) was 2.22 (2.02-2.43) for HFpEF and 2.73 (2.71-2.75) for HFrEF.…”

Section: Overall Analysis Of New-onset Heart Failure Risk In Relationmentioning

confidence: 99%

Diabetes mellitus and risk of new‐onset and recurrent heart failure: a systematic review and meta‐analysis

et al. 2020

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Despite mounting evidence of the positive relationship between diabetes mellitus (DM) and heart failure (HF), the entire context of the magnitude of risk for HF in relation to DM remains insufficiently understood. The principal reason is because new-onset HF (HF occurring in participants without a history of HF) and recurrent HF (HF re-occurring in patients with a history of HF) are not discriminated. This meta-analysis aims to comprehensively and separately assess the risk of new-onset and recurrent HF depending on the presence or absence of DM. We systematically searched cohort studies that examined the relationship between DM and new-onset or recurrent HF using EMBASE and MEDLINE (from 1 Jan 1950 to 28 Jul 2019). The risk ratio (RR) for HF in individuals with DM compared with those without DM was pooled with a random-effects model. Seventy-four and 38 eligible studies presented data on RRs for new-onset and recurrent HF, respectively. For new-onset HF, the pooled RR [95% confidence interval (CI)] of 69 studies that examined HF as a whole [i.e. combining HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)] was 2.14 (1.96-2.34). The large between-study heterogeneity (I 2 = 99.7%, P < 0.001) was significantly explained by mean age [pooled RR (95% CI) 2.60 (2.38-2.84) for mean age < 60 years vs. pooled RR (95% CI) 1.95 (1.79-2.13) for mean age ≥ 60 years] (P < 0.001). Pooled RRs (95% CI) of seven and eight studies, respectively, that separately examined HFpEF and HFrEF risk were 2.22 (2.02-2.43) for HFpEF and 2.73 (2.71-2.75) for HFrEF. The risk magnitudes between HFpEF and HFrEF were not significantly different in studies that examined both HFpEF and HFrEF risks (P = 0.86). For recurrent HF, pooled RR (95% CI) of the 38 studies was 1.39 (1.33-1.45). The large between-study heterogeneity (I 2 = 80.1%, P < 0.001) was significantly explained by the proportion of men [pooled RR (95% CI) 1.53 (1.40-1.68) for < 65% men vs. 1.32 (1.25-1.39) for ≥65% men (P = 0.01)] or the large pooled RR for studies of only participants with HFpEF [pooled RR (95% CI), 1.73 (1.32-2.26) (P = 0.002)]. Results indicate that DM is a significant risk factor for both new-onset and recurrent HF. It is suggested that the risk magnitude is large for new-onset HF especially in young populations and for recurrent HF especially in women or individuals with HFpEF. DM is associated with future HFpEF and HFrEF to the same extent.

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Excess risk of hospitalisation for heart failure among people with type 2 diabetes

Cited by 32 publications

References 24 publications

Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

Diabetes mellitus and risk of new‐onset and recurrent heart failure: a systematic review and meta‐analysis

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