Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. Findings from the rica registry

Abstract

Aim To determine if patients with heart failure and preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher comorbidity burden than those without T2DM, if other comorbidities are preferentially associated with T2DM and if these conditions confer a worse patient prognosis. Methods and results Cohort study based on the RICA Spanish Heart Failure Registry, a multicentre, prospective registry that enrols patients admitted for decompensated HF and follows them for 1 year. We selected only patients with HFpEF, classified as having or not having T2DM and performed an agglomerative hierarchical clustering based on variables such as the presence of arrhythmia, chronic obstructive pulmonary disease, dyslipidemia, liver disease, stroke, dementia, body mass index, haemoglobin levels, estimated glomerular filtration rate and systolic blood pressure. A total of 1934 patients were analysed: 907 had T2DM (mean age 78.4 ± 7.6 years) and 1027 did not (mean age 81.4 ± 7.6 years). The analysis resulted in four clusters in patients with T2DM and three in the reminder. All clusters of patients with T2DM showed higher BMI and more kidney disease and anaemia than those without T2DM. Clusters of patients without T2DM had neither significantly better nor worse outcomes. However, among the T2DM patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the worst being cluster 3 (HR 2.0, 95% CI 1.36‐2.93, P = .001). Conclusions Grouping our patients with HFpEF and T2DM into clusters based on comorbidities revealed a greater disease burden and prognostic implications associated with the T2DM phenotype, compared with those without T2DM.

A Comparative Change in Left Ventricular Mass Index on Echocardiography in Hypertensive Diabetic and Non-Diabetic Patients Taking Candesartan

“…The most significant finding of another study was that a serial decrease in LV mass in uncomplicated individuals with critical hypertension has a good prognostic value by foretelling a lower probability of developing cardiovascular disease in the future 15 . 8,16 The leading cause of overall diabetes morbidity and mortality remains to be heart disease, which develops eventually in the majority of individuals with DM. 17 Because LVH is a warning sign and a separate risk factor for sudden death, ventricular dysrhythmia, myocardial ischemia, coronary heart disease, and heart failure, increased LVM may be a factor in the increased cardiovascular risk.…”

Body mass index and clinical outcomes in patients with heart failure with preserved ejection fraction mediated by diastolic blood pressure status?

“…IR is closely associated with type 2 diabetes. Patients with type 2 diabetes and HFpEF co-morbidities have a higher BMI, greater disease burden, and worse prognosis compared to patients without type 2 diabetes [ 40 ].…”

Evaluating the adverse outcome of subtypes of heart failure with preserved ejection fraction defined by machine learning: a systematic review focused on defining high risk phenogroups

“…Patients with type 2 DM and HFpEF tend to have worse LV diastolic function (Wang et al, 2018[ 126 ]). Patients with type 2 DM and HFpEF show higher BMI and more kidney disease and anemia than those without type 2 DM (Arevalo-Lorido et al, 2021[ 5 ]). Although DM is often associated with co-morbidities, in HFpEF DM is a significant predictor of mortality and hospitalization for HF even after adjusting for factors such as age, BMI, NYHA class and renal function (Lejeune et al, 2021[ 65 ]).…”